Tuesday, June 23, 2009

Does Canada Really Make Patients Wait?

In the debate about a Government-run National Health Plan, impressions of the Canadian system loom over any proposal. The influence can be subtle, educated, or not. Often it degenerates into the exalted format of childhood arguments:"Does!" "Does not!" "Does too!" etc...

Waiting times for certain tests and surgery are thrown about and highlighted or trashed, but rarely is any data offered. Here is the 2008 Fraser Institute report "Waiting Your Turn", which provides a comprehensive look at the numbers. Take a look at it, some of the best graphs of the overall effects are on pages 57 and 58.

Highlights of the report include an average 8.5 week wait from referral to seeing a specialist, and another 8.7 weeks to receive the treatment recommended by that consultant. One of the shortest waits was medical oncology (think chemotherapy) which was 4.6 weeks from referral to treatment. Overall the wait times nearly doubled compared to 1993 (referral to treatment went from 9.3 weeks to 17.2 weeks in 2008).

One can well argue whether these waiting times are medically significant or not, whether this person or that person might have "had an untoward outcome" as a result.

My point instead is that Canada's medical system is not the health care nirvana that some claim. Canada has rationing by an ever lengthening queue. 

No national health care system can afford to pay for everything, for everyone, always.  All the handwaving about 'efficiencies' and EMRs will not conjure enough cash to prevent rationing, whether open or covert


  1. What are the mean wait times in the U.S.? Standard deviation?

    Without figures with which to compare the Canadian figures, this data is fairly meaningless: the amounts may seem outrageous to those who aren't used to dealing with a chronic illness, but, for those who deal with this daily, these numbers actually seem fairly lovely.

    I remember the first time I tried calling the specialist I wanted to see, soon after I got sick, and was told he could get me in six months later. I laughed/cried/hung up, and tried someone else (local, in my HMO, and without a clue), as I couldn't even fathom not seeing someone within the next six days, let alone being alive in six months.

    A year and a half later, I was still feeling just as awful (but still--much to my chagrin, at that point--quite alive), and, after dozens of wasted appointments and thousands of wasted dollars, I made an appointment with this guy I should have seen a year earlier. Surgery was schedule for another six months later. Years later and I'm still fighting, but, the idea that this wait is unique to Canada is utterly laughable.

    Perhaps *I'm* the outlier, but, using my own experience dealing with American healthcare as a guide, these waiting times seem fairly typical. I'm not sure, as a patient with a rare, chronic illness, that Canada's model is the way to go for me, personally, but this sure isn't the argument that's going to convince me at all.

  2. Canada is not alone, but like US HMOs they have deliberately used the queue for rationing. The HMOs have been excoriated for this in public, but the US Veterans Administration system usually gets a pass for the same thing.

    There can certainly be waiting for other reasons than deliberate rationing, but I cannot tell why you had a delay. The delay for my patients' referral appointments depends on many factors such as scarcity in that specialty and if the patient insists on the Medical School Mecca rather than a mere huge tertiary center.

    I have never had an initial appointment for my patient referral longer than 4 months out in 23 years of practice. I have never had one longer than 3 months to a non-Mecca and then only in one specialty.

    In a national system we will have the current covert rationing (see covertrationingblog.com)and will move into open rationing which can come in diverse forms. Waiting, gatekeepers, age, effective-but-too-expensive, 'too new' and other devices will be used.

    There is no guarantee a National system would have helped you any faster. It might have refused to cover it entirely.

    In a Federal system your health care might be decided by a career medicrat with a MA in agricultural archaeology.