Reducing Wait Times for Health Care: What Canada Can Learn from Theory and International Experience

Public opinion polls in recent years show that Canadians are generally satisfied with their government-funded health care system. If there is any consistent source of dissatisfaction with the “single-payer” system, it is with the amount of time people wait to receive medical care. Requiring patients to queue for medical services presumably saves the government money, at least in the short-run, by reducing expenditures on hospitals and doctors. However, waiting lists impose monetary and non-monetary costs on those waiting for health care. The larger these costs, the more likely it is that waiting lists have net overall costs for Canadian society. What can and should be done to reduce or eliminate wait times for health care? Reducing Wait Times for Health Care: What Canada Can Learn from Theory and International Experience assesses various policy-related issues associated with waiting lists for health care services in Canada. First, Nadeem Esmail attempts to define what “waiting” for health care means and considers the complexities involved in comparing wait times from one country to another. In chapter 3, Dr. Brian Day examines the substantial costs that waiting for health care impose on Canadians. David Henderson then considers various policy approaches for reducing wait times in Canada, while in chapter 5, Steven Globerman addresses the labour market consequences of wait times and the broader impacts of wait times for Canada’s economic growth. Finally, in chapter 6 of this volume, Nadeem Esmail reviews the international experience with wait times and reductions in wait times in an effort to identify policies that might work to improve the timeliness of access to health care in Canada. A key point for Canadian policymakers emerges from the chapters in this book: maintaining status quo health care policies is unlikely to improve the timeliness of the provision of health care services in Canada or improve the efficiency of the government-funded system.

[1]  D. Gratzer,et al.  Code Blue: Reviving Canada's Health Care System , 1999 .

[2]  Bacchus Barua,et al.  Waiting Your Turn: Wait Times for Health Care in Canada, 2012 Report , 2010 .

[3]  M. Tanner The Grass is Not Always Greener: A Look at National Health Care Systems around the World , 2008 .

[4]  Are waiting times for hospital admissions affected by patients' choices and mobility? , 2011, BMC health services research.

[5]  Hyoung-Sun Jeong,et al.  An assessment of the performance of the Japanese health care system , 2001 .

[6]  S. Derrett,et al.  Waiting for elective surgery: effects on health-related quality of life. , 1999, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[7]  J. Huisman The Netherlands , 1996, The Lancet.

[8]  G. Brandrup-Wognsen,et al.  Mortality on the waiting list for coronary artery bypass grafting: incidence and risk factors. , 2004, The Annals of thoracic surgery.

[9]  T. To,et al.  Risk of incarceration of inguinal hernia among infants and young children awaiting elective surgery , 2008, Canadian Medical Association Journal.

[10]  Jeremy Hurst,et al.  Explaining Waiting Times Variations for Elective Surgery Across OECD Countries , 2003 .

[11]  J. Tijssen,et al.  Morbidity and mortality in patients waiting for coronary artery bypass surgery. , 2001, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[12]  L. Siciliani,et al.  Do waiting times reduce hospital costs? , 2009, Journal of health economics.

[13]  OECD ECONOMIC SURVEY OF THE UNITED KINGDOM 2004 : ACTIVITY-BASED FUNDING , INCENTIVES AND WAITING TIMES IN HEALTH CARE , 2004 .

[14]  G. Anderson,et al.  Patients' acceptance of waiting for cataract surgery: what makes a wait too long? , 1997, Social science & medicine.

[15]  R. Kessler,et al.  Health and Productivity as a Business Strategy: A Multiemployer Study , 2009, Journal of occupational and environmental medicine.

[16]  James G Wright,et al.  Waiting for children’s surgery in Canada: the Canadian Paediatric Surgical Wait Times project , 2011, Canadian Medical Association Journal.

[17]  P. Rothwell,et al.  Population-based study of delays in carotid imaging and surgery and the risk of recurrent stroke , 2005, Neurology.

[18]  A. Rush,et al.  Workplace performance effects from chronic depression and its treatment. , 1998, Journal of health economics.

[19]  R. Foglia,et al.  Impact of wait time on outcome for inguinal hernia repair in infants , 2009, Pediatric Surgery International.

[20]  D. Feeny,et al.  Health-related quality of life and mobility of patients awaiting elective total hip arthroplasty: a prospective study. , 2002, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[21]  Jeremy Hurst,et al.  Tackling Excessive Waiting Times for Elective Surgery: A Comparison of Policies in Twelve OECD Countries , 2003 .

[22]  Jeremy Hurst,et al.  Tackling excessive waiting times for elective surgery: a comparative analysis of policies in 12 OECD countries. , 2005, Health policy.

[23]  A. Kalwij,et al.  Health and labour force participation of older people in Europe: what do objective health indicators add to the analysis? , 2008, Health economics.

[24]  J. Cox,et al.  Managed delay for coronary artery bypass graft surgery: the experience at one Canadian center. , 1996, Journal of the American College of Cardiology.

[25]  Astrid Guttmann,et al.  Association between waiting times and short term mortality and hospital admission after departure from emergency department: population based cohort study from Ontario, Canada , 2011, BMJ : British Medical Journal.

[26]  A. Levy,et al.  Methods for studying adverse events on surgical wait lists , 2006, Health Services and Outcomes Research Methodology.

[27]  A. Gafni,et al.  Waiting for hip revision surgery: the impact on patient disability. , 2008, Canadian journal of surgery. Journal canadien de chirurgie.

[28]  Valérie Paris,et al.  HEALTH SYSTEMS INSTITUTIONAL CHARACTERISTICS: A SURVEY OF 29 OECD COUNTRIES , 2010 .

[29]  S. Yusuf,et al.  The risks of waiting for cardiac catheterization: a prospective study. , 2002, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[30]  Luigi Siciliani,et al.  Waiting Time Policies in the Health Sector: What works? , 2013 .

[31]  B. Masri,et al.  Delays Worsen Quality of Life Outcome of Primary Total Hip Arthroplasty , 2006, Clinical orthopaedics and related research.

[32]  Jack V Tu,et al.  Measuring and reducing waiting times: a cross-national comparison of strategies. , 2007, Health affairs.

[33]  G. Kalb,et al.  Health status and labour force participation: evidence from Australia. , 2006, Health economics.

[34]  Jukka Paastela Finland , 2002 .

[35]  Patrick K. Plunkett,et al.  Increasing wait times predict increasing mortality for emergency medical admissions , 2011, European journal of emergency medicine : official journal of the European Society for Emergency Medicine.

[36]  E. Freeman,et al.  Cataract-related vision loss and depression in a cohort of patients awaiting cataract surgery. , 2009, Canadian journal of ophthalmology. Journal canadien d'ophtalmologie.

[37]  Joachim Doll,et al.  Organization for Economic Cooperation and Development , 2021, International Organization.

[38]  Nadeem Esmail,et al.  How Good Is Canadian Health Care? 2008 Report An International Comparison of Health Care Systems , 2004 .

[39]  J. Ruedy,et al.  Undergraduate and postgraduate medical education in Canada. , 1998, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[40]  J. Newhouse Free for All?: Lessons from the RAND Health Insurance Experiment , 1993 .

[41]  G Jambroes,et al.  Death on the waiting list for cardiac surgery in the Netherlands in 1994 and 1995 , 1999, Heart.

[42]  K. Tatara,et al.  Japan. Health system review. , 2009 .

[43]  R. B. Matthews,et al.  Health Care Reform: Why Not Best Practices? , 2011 .

[44]  J. Currie Healthy, Wealthy, and Wise: Socioeconomic Status, Poor Health in Childhood, and Human Capital Development , 2008 .

[45]  C. Sanmartin Toward Standard Definitions for Waiting Times , 2003 .

[46]  Reducing wait time for cataract surgery: comparison of 2 historical cohorts of patients in Montreal. , 2010, Canadian journal of ophthalmology. Journal canadien d'ophtalmologie.

[47]  Myde Boles,et al.  The Relationship Between Health Risks and Work Productivity , 2004, Journal of occupational and environmental medicine.

[48]  K. Buth,et al.  Waiting for Cardiac Surgery: Results of a Risk-Stratified Queuing Process , 2001, Circulation.

[49]  R. Leu,et al.  The Swiss and Dutch Health Insurance Systems: Universal Coverage and Regulated Competitive Insurance Markets , 2009 .

[50]  Lisa Kuramoto,et al.  Cumulative incidence for wait-list death in relation to length of queue for coronary-artery bypass grafting: a cohort study , 2006, Journal of cardiothoracic surgery.

[51]  R. Moss,et al.  True versus reported waiting times for valvular aortic stenosis surgery. , 2006, The Canadian journal of cardiology.

[52]  D. Cutler,et al.  Queuing for coronary angiography during severe supply-demand mismatch in a US public hospital: analysis of a waiting list registry. , 1999, JAMA.

[53]  G. Haywood,et al.  Disease progression and adverse events in patients listed for elective percutaneous coronary intervention , 2005, Postgraduate Medical Journal.

[54]  Henry Ahn,et al.  The impact of surgical wait time on patient-based outcomes in posterior lumbar spinal surgery , 2007, European Spine Journal.

[55]  L. Siciliani,et al.  Measuring waiting times across OECD countries , 2013 .

[56]  John Eyles,et al.  Waiting Your Turn: Hospital Waiting Lists in Canada , 1994 .

[57]  W. Mackillop,et al.  A comparison of delays in the treatment of cancer with radiation in Canada and the United States. , 1995, International journal of radiation oncology, biology, physics.

[58]  D. Jamison,et al.  International differences in the impact of doctors on health: a multilevel analysis of OECD countries. , 2005, Journal of health economics.

[59]  C. Flood,et al.  Is Canada odd? A comparison of European and Canadian approaches to choice and regulation of the public/private divide in health care , 2009, Health Economics, Policy and Law.

[60]  János Kornai The Socialist System: The Political Economy of Communism , 1992 .

[61]  C. Dewa,et al.  Chronic physical illness, psychiatric disorder and disability in the workplace. , 2000, Social science & medicine.

[62]  Unique mixtures of public and private funding in Japan - The ban on billing for mixed medical care service † - , 2012 .

[63]  E. van Ginneken,et al.  The Netherlands: health system review. , 2016, Health systems in transition.

[64]  A. Sharpe,et al.  State of the Evidence on Health as a Determinant of Productivity , 2011 .

[65]  Patrick J O'Connor,et al.  Does improved access to care affect utilization and costs for patients with chronic conditions? , 2004, The American journal of managed care.

[66]  R. Deber,et al.  Medical Savings Accounts: will they reduce costs? , 2002, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[67]  C. Smee,et al.  United Kingdom , 2000, International Journal of Pharmaceutical Medicine.

[68]  A. Levy,et al.  Do Longer Delays for Coronary Artery Bypass Surgery Contribute to Preoperative Mortality in Less Urgent Patients? , 2006, Medical Care.

[69]  A. Lalonde Canadian Institute for Health Information. , 1994, Canadian journal of medical technology.

[70]  J. Sampalis,et al.  Impact of waiting time on the quality of life of patients awaiting coronary artery bypass grafting. , 2001, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[71]  Mike Smet,et al.  Multi-product costs and standby capacity derived from queuing theory: the case of Belgian hospitals , 2004 .

[72]  K Sykora,et al.  Waiting for coronary artery bypass surgery: population-based study of 8517 consecutive patients in Ontario, Canada , 1995, The Lancet.

[73]  M. Gleave,et al.  Does prolonging the time to prostate cancer surgery impact long-term cancer control: a systematic review of the literature. , 2006, The Canadian journal of urology.

[74]  William L. Megginson,et al.  Forthcoming, Journal of Economic Literature FROM STATE TO MARKET: A SURVEY OF EMPIRICAL STUDIES ON PRIVATIZATION , 2000 .

[75]  R. Osborn,et al.  International Profiles of Health Care Systems: Australia, Canada, Denmark, England, France, Germany, Japan, Iceland, Italy, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United States , 2012 .

[76]  C. Bombardier,et al.  Waiting times for knee-replacement surgery in the United States and Ontario. , 1994, The New England journal of medicine.

[77]  N. Roos,et al.  Does universal comprehensive insurance encourage unnecessary use? Evidence from Manitoba says "no". , 2004, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[78]  J. M. Quintana,et al.  Factors and Consequences of Waiting Times for Total Hip Arthroplasty , 2011, Clinical orthopaedics and related research.

[79]  Ronald C. Kessler,et al.  Health and Productivity as a Business Strategy , 2007, Journal of occupational and environmental medicine.

[80]  Margaret C. Levenstein,et al.  DIRECTORATE FOR FINANCIAL AND ENTERPRISE AFFAIRS COMPETITION COMMITTEE , 2007 .

[81]  Tanya Horsley,et al.  The consequences of waiting for cataract surgery: a systematic review , 2007, Canadian Medical Association Journal.

[82]  C M Flood,et al.  The illegality of private health care in Canada. , 2001, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.