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(Anthony Jenkins/The Globe and Mail)
(Anthony Jenkins/The Globe and Mail)

Neil Reynolds

The price we pay for spending 6.2 hours in the ER Add to ...

Scottish playwright and novelist J.M. Barrie tells us, on the very first page of Peter and Wendy, that Wendy knew at 2 that she must grow up. Humans are spared a conscious recognition of mortality, he wrote, for the briefest of time. "Two," he wrote, "is the beginning of the end."

Time is in short supply and, hence, commonly regarded as an honest medium of exchange: Time is money. It follows that time has a price, however puzzling its variations. A doctor's time may not be worth much more than a mechanic's time. But an emergency-room doctor's time can be worth more than the combined time of all of the people who cram hospital waiting rooms - the people who "spend" long hours awaiting medical consultation and treatment.

What price do people pay for the hours they sit in emergency rooms and walk-in clinics? In a novel analysis of the price of time, Ontario economist Predrag Rajsic says we pay much more than we think. By his calculation, it would cost less to ration medical services by money - presumably with user fees and insurance premiums - than to ration them by time.

Prices usually express the economic evaluations of millions of people, Mr. Rajsic notes - producing "harmony" between the quantity of goods demanded and the quantity of goods supplied. When prices are not permitted to perform this function, "something else will." In government-run, centrally administered monopolies, "something else" includes lineups.

The important distinction is that, when money changes hands, the value of the payment gets passed forward and preserved far into the future. When time replaces money, however, no such preservation occurs. "Paying for a service with time represents outright resource destruction," Mr. Rajsic says. "The time spent in waiting is lost forever. It cannot be used again in any productive activity."

In a paper published recently by the Ludwig von Mises Institute, Mr. Rajsic, also a PhD candidate at the University of Guelph, conducts a forensic analysis of ER wait times - based in part on his own observations. "Like most parents of young children in Canada," he writes, "my wife and I have spent a fair share of our first six years of parenthood waiting for service in emergency rooms. We had ample time to observe."

Mr. Rajsic observed "remarkable stability" in the waiting process at Kitchener-Waterloo's main emergency room. About 30 people wait at all times. Once an hour, a nurse calls five of these people to adjacent waiting rooms, where they are examined by a doctor. In the next hour, another five people arrive. "Thus, whenever a new person comes into the waiting room, there are about 30 people already waiting. Because the doctor examines about five people an hour, it takes approximately six hours until this most recent person is admitted. But, because five people enter the room every hour, there will be 30 new people in the room every six hours."

Ontario's official wait-time records confirm Mr. Rajsic's observations. At Grand River Hospital in Kitchener-Waterloo, the average wait time (triage to discharge) for minor cases is 6.2 hours - 11 hours for serious cases. Wait times vary substantially, but the average ER time for relatively minor cases in Ontario is 4.4 hours. Since Ontarians make 5.25 million visits a year, they "spend" at least 23 million hours in ER. You could probably double this to get a national number: almost 50 million hours. This is roughly equivalent to the combined lifespan of about 75 people a year. (This calculation doesn't include the time-price of people who accompany patients, although it should.)

If you reduce wait times by assigning more doctors and nurses to ER duty, you merely transfer gains in ER to losses elsewhere in the system. Equally important, you induce more people to join the ER waits. "Long wait times," Mr. Rajsic says, "are here to stay." Call it Rajsic's Law: Any action that reduces waits for monopoly-delivered services increases the number of people in the lineup.

Ironically, the most economically effective way to reduce ER wait times would be to increase them. Make it 12 hours for minor cases and far fewer people would use emergency services for minor complaints.

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