Wait times—the other health-care crisis

It has been more than a year since the first case of COVID-19 was confirmed in Canada. Since then, more than one million Canadians have tested positive for the virus, which has claimed the lives of more than 23,000. The pandemic, and the consequent lockdowns, have also ravaged our economy and forced the government to spend more per person than we did during the Second World War.

Less discussed, however, are the effects of another perennial health-care crisis that’s only gotten worse over the last year—long wait times for health care.

In 2020, the average total wait time between referral from a GP and receiving care was measured at 22.6 weeks—the longest wait recorded in the 30-year history of the Fraser Institute’s annual survey and 143 per cent larger than the 9.3-week wait recorded in 1993.

It may be tempting to blame our current predicament on COVID, and certainly several provinces across Canada have made difficult decision to postpone elective treatments in anticipation of surging COVID cases. However, while these cancellations may well have exacerbated wait times, they are not the cause. For example, in 2019 Canadian patients experienced a total 20.9 week wait for medically necessary care, well before the pandemic started.

These wait times are not benign inconveniences. They can result in physical pain and suffering, poorer medical outcomes and in some cases cause permanent disability or even death. Reduced productivity and income are a consequence of these wait times, resulting in an economic cost for patients and the economy more generally.

A recent study attempted to attach a dollar value to the time Canadians lost between seeing a specialist and receiving treatment (a 12.1-week wait). In 2020, the elective surgery queue cost 1.2 million Canadians a total of $2.8 billion (or $2,254 per person) in lost wages and productivity. This estimate only includes hours Canadians spend working during the average workweek. When we expand our analysis to include the value of time spent in a diminished capacity outside of work (but excluding eight hours for sleep), this figure increases to $8.4 billion (or $6,838 per person). Importantly, these cost estimates do not account for time it takes to see a specialist in the first place (10.5 weeks), which also carries its own risk for increased morbidity.

These waits are not an unavoidable cost of universal care. For example, in 2016, the Commonwealth Fund found that a significant number of Canadians (18 per cent), the highest proportion recorded that year, reported waiting four months or longer for elective surgery. This figure was striking when compared with other universal countries such as Australia (8 per cent), Switzerland (6 per cent) and Germany (0 per cent).

Of course, like Canada, many of these countries will likely experience increased wait times for treatment, given COVID-related delays in elective surgeries just about everywhere. However, a more recent version of this international survey, taken between March 2020 and July 2020, similarly found that Canadians were the least likely to report waiting under four months for an elective procedure. And these other countries will likely return to much shorter wait times once the pandemic passes.

We were barely two months into the pandemic when we first wrote about the impact COVID was having on our already strained health-care system. Now, as of May 2021, we’re climbing into a third wave while viral variants and increasing hospitalizations begin to overwhelm provincial health-care systems once again. To point out and recognize the heroic efforts of our health-care workers, considering all they’ve endured this year, does not seem as though its enough. Our provincial governments also deserve recognition, especially as they face incredibly difficult decisions once again.

However, as provinces begin to postpone elective surgeries once again, we shouldn’t forget our other perennial health-care crisis. Postponement or not, we’ve known for some time that long waits for medically necessary care can and do result in serious consequences. While provinces such as British Columbia have had major successes with surgical renewal programs, the improvements are only temporary. To shorten wait times, fundamental reforms will be required.