The Doctor Will See You in 18.2 Weeks

Published January 12, 2015

A report by a Canadian think tank documents long waits for necessary medical care in Canada’s government-run, single-payer health care system. Canada’s single-payer health care system is frequently touted as a model for the United States to follow.

According to the report by Bacchus Barua and Frazier Fathers of the Fraser Institute, Canadians wait for necessary medical treatments an average of 18.2 weeks between referral from a general practitioner and the time the patient receives treatment from a specialist.

The authors found the average wait time is 96 percent longer than in 1993, when it was just 9.3 weeks.

“Canada rations [care] through long waiting times and limited access,” said Dr. Roger Stark, a health care policy analyst at the Washington Policy Center and a retired physician. “These long waits would not be acceptable to Americans, who are rightly accustomed to timely health care.”

The Fraser report was the 25th annual report on wait times in Canada, surveying specialist physicians across 10 provinces and 12 specialties.

Variation in Waits

The wait times reported by Barau and Fathers are median waits, meaning half the patients are seen in less than the reported time and half must wait more than the average time.

The report found a great deal of variation between provinces in the total wait times patients face. Ontario has the shortest total wait, 14.1 weeks, followed closely by Saskatchewan, with an average wait of 14.2 weeks.

At the other end of the spectrum, patients in New Brunswick have the longest wait, at 37.3 weeks, with Prince Edward Island reporting waits of 35.9 weeks and Nova Scotia patients waiting 32.7 weeks.

Wait times also varied by specialty. The longest wait is for orthopedic surgery, 42.2 weeks, while neurosurgery patients wait an average of 31.2 weeks. Cancer patients have relatively short waits, only 3.3 weeks for medical oncology and 4.2 weeks for radiation oncology. Elective cardiovascular surgery patients wait 9.9 weeks.

Barua told Health Care News Canadian taxpayers are funding a very expensive system that’s failing to deliver timely access to health care for patients in need of medically necessary treatment.

“Wait times have become a defining feature of Canada’s health care system, and they can have serious consequences,” Barua said. “For example, they may force some patients to endure months of physical pain and mental anguish, they may result in lower worker productivity and forgone wages, they can sometimes result in a potentially treatable illness being transformed into a debilitating permanent condition, and in the worst cases they may result in death.”

Wait Lists Growing

Barua says it’s easy to understand what hasn’t caused waiting times to soar from 9.3 weeks in 1993 to 18.2 weeks in 2014.

“It clear that it is not likely due to insufficient funding, as health care expenditure per capita increased about 51 percent—after adjusting for inflation—during the period,” Barua said. “We also currently have one of the most expensive universal health care systems in the world. We’re just not receiving commensurate value in return.”

Barua points to the nature of single-payer health care as the cause of the waits. “The necessity to ration health care through wait times essentially results from an basic imbalance between demand and supply, a situation that is a product of the government monopoly on the financing and delivery of core medical services, the lack of appropriate incentives for providers, and the absence of means-tested cost-sharing for patients,” explained Barua.

Costs of Bureaucracy

Dr. John Dale Dunn, an emergency physician and policy advisor to The Heartland Institute, identifies the bureaucratic nature of Canadian health care as a source of the problem.

“The reason this happens is that a province gets a global budget which is arbitrarily set by bureaucrats with no effort made to respond to what people need,” Dunn said. “The people in control of this money know they must spend everything, but not go over the budget, so they do this by restricting access.”

Dunn described how the incentive for bureaucrats is to treat less-serious cases ahead of patients with more serious medical issues in order to avoid going over budget.

“Say you need an operation, you are by definition in the Canadian system defined as an outlier,” explained Dunn. “You are going to have to bang on the door to get any treatment. So what they do is fill their beds with people who don’t have [a need for] exotic care, and this restricts access” for patients with expensive and complex medical needs.

“This is indirect rationing; it’s the kind of thing that is bound to happen with global budgets,” Dunn said. “Almost 30 years ago I started to see doctors leaving Canada because they were disgusted with the system because it prevented them from treating patients.”

U.S. Single Payer Advocates

Despite the continued problem of long waits for needed medical care, as well as the recent abandonment of a single-payer health system by longtime proponent Gov, Peter Shumlin of Vermont, there remains some support in the United States for moving toward a completely government-financed health system.

The New York State Assembly’s health committee held a hearing January 13 on Assembly Health Committee Chair Richard Gottfried’s (D-Manhattan) legislation to adopt single-payer health care in New York state.

Kenneth Artz ([email protected]) is a freelance writer for The Heartland Institute.

Internet info: “Waiting Your Turn,” Fraser Institute, November 2014: