An unfortunate reality of Canadian health care, is that long wait times that have characterized it for years have made us come to accept delayed treatment as the norm.
What we often forget is that while some patients may be able to wait for treatment, others may be in considerable physical pain, may experience mental stress, and may have their illness worsen during their wait (ironically requiring more complex and costly treatment in the future).
It is, of course, very difficult to assign a dollar figure to such personal experiences. However, one way to estimate a portion of the privately borne cost of waiting for treatment is to calculate the dollar cost of time and productivity (measured using average wages) lost by a patient while waiting for treatment.
A new study by the Fraser Institute estimates that the 894,449 Canadians who (on average) waited 9.8 weeks for treatment after seeing a specialist, experienced a personal cost of $1,304 in lost productivity and income. This adds up to an almost $1.2 billion loss for the Canadian economy.
And this is surely a conservative figure, since it does not place any intrinsic value on the time Canadians spend waiting in a reduced capacity outside of the typical work week. (Valuing all hours of the week – including evenings and weekends, but excluding eight hours of sleep – the cost estimate increases to $3.5 billion or $3,951 per patient.) Nor does it factor in the 8.5 week wait to see a specialist in the first place, the cost of care provided by family members and friends, or the risk of disability, adverse medical consequences, and in the worst cases, death.
It would be one thing if long wait times (and their consequences) were the necessary price to pay for a universal health-care system.
However, nothing could be further from the truth. Several countries, including Australia, France, Germany, the Netherlands, Sweden and Switzerland, ensure universal health care for their residents for about the same cost as Canada (measured as a percentage of the economy, and adjusted for age) but with remarkably shorter wait times.
There are three key differences in the way these countries finance and deliver universal health care. First, they generally allow private companies to operate in either the insurance or hospital sectors – stimulating competition, increasing capacity, and providing an alternative when the public system fails.
Second, each of these countries also expects patients to share in the cost of treatment, thereby encouraging the responsible use of scare health-care resources. Of course, in order to make sure that they never cause undue financial burden, there are usually annual limits on such payments, and vulnerable groups (such as the elderly, the chronically ill, and pregnant mothers) are usually exempt.
Finally, hospitals in these countries are more commonly financed through a system of activity-based funding instead of global budgets. By doing so, hospitals are incentivized to treat more patients and compete for funding, instead of simply staying within a budget determined by government.
There are clearly a multitude of policy options that can be pursued to help ensure more timely treatment for patients in Canada without sacrificing the universal nature of our health-care system. However, the seeming acceptance of long wait times in this country by politicians and policymakers suggests that patients will continue to experience high personal costs in terms of valuable time lost while waiting for the treatment they desperately need.
Bacchus Barua is a senior economist in the Fraser Institute’s Centre for Health Policy Studies.
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