With a full year of life-with-COVID behind us, and the hope of mass vaccination on the horizon, it’s time for policymakers to refocus some of their attention on our other health care crisis—long wait times for medical care. Although the number of patients affected by wait times are rarely included in televised updates from provincial health care officials, they shouldn’t be ignored.
According to our latest wait-times report, last year patients in Canada faced an estimated median wait of 22.6 weeks (10.5 weeks to see a specialist,12.1 weeks to receive treatment) for medically necessary elective care across 12 specialties, the longest wait in the report’s 30-year history.
Accounting for just the wait from specialist appointment to treatment, the survey estimates more than 1.2 million Canadians waited for treatment last year.
Of course, some of this backlog is due to COVID-19 related closures. Across Canada, provincial health ministers made the difficult decision to cancel thousands of elective surgeries to ensure scarce medical resources would be available for new COVID cases. However, the waiting list in 2019 was almost as long (1.1 million).
So, while it’s likely that a significant portion of the 160,000 jump in the number of patients waiting in 2020 can be attributed to surgical slowdowns at the start of the pandemic, our health-care system has rationed care for decades. COVID-19 has exacerbated the problem, but it’s not the primary cause of our wait time crisis.
Moreover, individual patients have borne the cost of last year’s surgical slowdowns combined with already long wait times. Although we’re constantly reminded of the consequences of COVID, the consequences of unreasonable waits for surgery can range from physical pain and psychological distress to permanent disability and death.
In addition to these physical consequences, patients also suffer adverse economic effects. Our new study estimates the total economic cost of waiting for treatment (after seeing a specialist) in 2020 was $2.8 billion (or $2,254 per patient) in lost wages and productivity. When we include the value of time patients spend in a reduced condition outside work (but excluding eight hours of sleep) this figure balloons to $8.4 billion (or $6,838 per patient). And these cost estimates exclude the 10.5 week-wait to see a specialist in the first place.
Of course, we often hear that rationing care—and the subsequent burden on patients—is an unfortunate but necessary tradeoff for universal coverage. But international experience tells a much different story. In 2016, the Commonwealth Fund found that 18 per cent of Canadians reported waiting more than four months for elective surgery, the largest percentage among the 11 countries examined and significantly longer than in Australia (8 per cent), Switzerland (6 per cent), and Germany (0 per cent), among others. A more recent Commonwealth Survey presents similar findings from last year, with Canada reporting the lowest percentage of people waiting less than fourth months for non-emergency elective surgery.
So while all these countries also deal with their own COVID-related backlogs, they will likely return to a very different “normal” wait list compared to Canada once the crisis abates.
The provinces have worked hard to renew their surgical programs, yet key questions remain. Will the short-term investments be enough to tackle the perennial problem of wait times? Or in the absence of fundamental reforms, will Canadians continue to bear the burden of long wait times?
Mackenzie Moir and Bacchus Barua are analysts at the Fraser Institute.