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Long Waits for Health Care Plague Canada

Canadians seeking health care continue to be plagued by long waits, according to a recent report from The Fraser Institute.

Released in October 2005, Waiting Your Turn: Hospital Waiting Lists In Canada found the median wait from the time a patient was referred by a general practitioner until the time he or she actually received treatment was 17.7 weeks. (Median wait means half of all patients waited less and half waited longer.)

The report by Nadeem Esmail, senior health policy analyst for Fraser, and Michael Walker, senior fellow and president of the Fraser Institute Foundation, was the fifteenth annual study of wait lists for health care in Canada.

Waits varied by province and by specialty, the study noted. Ontario had the shortest median wait at 16.3 weeks, while Saskatchewan had the longest, 25.5 weeks. Cancer patients had the shortest median wait--5.5 weeks for medical oncology and 5.7 weeks for radiation oncology. Orthopedic patients had the longest waits, at 40 weeks.

There is no comparable measurement for waits in the United States because health care generally remains in the private sector and long waits for needed care are typically not a problem.

Long Waits Harm Patients

Such long waits for needed care jeopardize patient health, according to many doctors and health policy experts. A 2004 survey of Canadian health care professionals, conducted by Ipsos-Reid on behalf of the Canadian Medical Association and Canadian Nurses Association, revealed significant concerns.

"The primary consequence of delayed access [to health care] is the worsening conditions of their patients," the survey found. It also reported 12 percent of physicians and 4 percent of nurses believe they have had patients die specifically because of long waits for needed care.

"Long waits can have several consequences," explains Dr. Robert Hamilton, a retired surgeon in Illinois. "Chronic conditions can become acute, with increased morbidity and mortality, and curable malignancies may become incurable." Hamilton also notes many orthopedic procedures, such as hip replacement and knee replacement, are done to relieve pain, which can be severe while a patient is forced to wait.

Canadians fed up with waiting months or even years for treatment are finding ways around the government-run system. CBS News reported in a March 20, 2005 story the tale of Jane Pelton of Ottawa, mother of a teenager who was told it would take up to three years for surgery to repair a torn knee ligament. Rather than watch her daughter wear a knee brace and suffer for three years, Pelton opted to go to a private clinic in Vancouver for surgery, which cost $3,300.

"Every day we're paying for health care, yet when we go to access it, it's just not there," said Pelton, in comments aimed at the government system her taxes pay for and is supposed to guarantee free care. "It's like somebody's telling you that you can buy this car, and you've paid for the car, but you can't have it right now."

Patients Sue for Care

Some Canadians have resorted to lawsuits to get the care they need in what they and their doctors believe is a reasonable time. In June 2005, the Supreme Court of Canada ruled Quebec could not ban private health insurance for services covered under the government-run system. The lawsuit was brought by a Canadian doctor, Jacques Chaoulli, and Montreal businessman George Zeliotis, who waited a year for hip replacement surgery.

"Access to a waiting list is not access to health care," the Supreme Court said in its ruling striking down Quebec's ban.

A similar lawsuit was filed in Quebec on behalf of 10,000 women with breast cancer who were forced into long waits for radiation therapy. Anahit Cilinger was one such patient. After having a lymph node removed in October 1999, she was put on a waiting list for radiation therapy. Three months later and with no end to the waiting in sight, she traveled to her native Turkey and paid $12,000 for the treatment.

"I don't want other sick people to have to go through the kind of suffering I did," Cilinger told Ingrid Peretz of The Globe and Mail in a March 10, 2004 interview.

Budget Approach Main Culprit

Canada's government-run health care system has long been plagued by wait lists, due in large part to the system's reliance on global budgets as a cost-control measure. Under global budgets, the government sets an overall limit on how much it will pay for health care, which forces hospitals and doctors to restrict the availability of care.

John Graham, director of health care studies at the Pacific Research Institute and a former resident of Canada, has long criticized global budgets as the cause of long waits. "Generally speaking, provincial governments give fixed, global budgets to hospitals annually," Graham said. "Therefore, when a patient is admitted to a hospital, it costs the hospital money instead of earning it. This means hospitals have no incentive to cut down waiting lists."

In the United States, several states have considered enacting a single-payer system that would impose global budgets on health care spending for their citizens. California and Oregon voters have rejected initiatives to establish single-payer systems, and in 2005 Vermont's state legislature passed a scaled-down single-payer bill that was later vetoed by Gov. Jim Douglas (R).

Long Waits Likely to Continue

The authors of Waiting Your Turn do not see an end to excessive waits for needed care in Canada any time soon. The Canadian federal government pledged in 2004 to increase spending on health care by $41 billion (Canadian) over the next 10 years to address wait lists, but Esmail and Walker point to the fact that additional spending in the past has not led to reductions in wait times.

"[P]rovinces that spend more on health care are not rewarded with shorter waiting lists," Esmail and Walker write. They conclude that as long as Canada keeps a single-payer health care system, Canadian patients will continue to be forced into long waits for needed care. "[U]nder the current regime--first-dollar coverage with use limited by waiting, and crucial medical resources priced and allocated by government--prospects for improvement are dim."

"Many Americans look to Canada's Medicare program as a panacea for what they perceive to be the American health care system's failures," Esmail told Health Care News. "These wonderful visions of Canada's socialized health program tend to ignore the very real costs that system imposes on Canadians in need of medically necessary care: long wait times that can stretch into months or even years of painful and detrimental delay. The reality is that Canada's Medicare program is a model for no one, not even Canada."

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