Change System to Fix Waiting Lists

Over the last week, roughly 90 people served by the Saskatoon health authority have been told that they will have to wait one month longer in pain and discomfort because of a budgetary shortfall. Though patients served by the Regina Health Region have been spared the cancellations, the budgetary and capacity issues there are no less real. But are the budgetary shortfalls and the resulting cancellations caused by a lack of health spending or by an inefficient use of those funds?

First, some national numbers for perspective. Canada, on an age adjusted basis, operates the most expensive universal access health care system in the OECD. In exchange for that high level of spending, Canadian governments provide some of the lowest levels of access to physicians and technology found in the OECD, while Canadian patients experience only middle of the road health outcomes. Put another way, Canadian taxpayers are paying for a world-class health care system, while getting service that can range from mediocre to terrible.

Amongst the Canadian provinces, Saskatchewan manages a similar performance. According to the Canadian Institute for Health Information, on a demographic adjusted basis, the Saskatchewan government ranked sixth in health expenditures for the year 2001, just below the Canadian average. But for all that spending, Saskatchewan patients experienced below average access to physicians and medical technologies, and suffered the longest waiting lists for elective medical procedures in the country. A below-par performance in a country that, as a whole, performs poorly yet spends a great deal suggests that there are serious problems with the health care program other than the money spent on it.

The problem of a lack of access to care in a high-cost system stems from the design of the system itself: Canada’s health care system is a massive, centrally controlled, government bureaucracy. And in the true tradition of government bureaucracies, it sucks up increased funding with almost no change in the functioning of the system or the outcomes from it. The fact that patients are stuck waiting almost seven months for elective care in Saskatchewan, or that some patients who were going to get their surgeries must now wait one month more, will not change if more funding is made available to the health care system.

The solution can, however, be found abroad, in countries like Sweden, France, Australia, and Japan, where universal access health care systems are functioning for less money than ours and providing better access to care and better health outcomes for the population. Each of these countries embraces the “compassionate approach” to health services by promising all citizens access to care regardless of ability to pay, yet none has followed Canada’s model of health care delivery.

Each of these countries offers choice in the delivery of health care services by allowing, and in some cases encouraging, the purchase and provision of competitive private health insurance. Each of these countries has a cost-sharing system in place, since patients are encouraged to make a more informed decision about how they use health services when care is not free at the point of use.

Finally, none of these countries is mired in a fear of for-profit care delivery, because they all understand that profits are what motivate health care providers to respond to patients’ needs.

For patients in Saskatchewan, adopting the policies found in these other OECD countries would mean access to a better, more patient-oriented universal access health care system, where all patients received the care they desired and did not have to wait for the care the government was willing to provide them. Comparative access to technology would improve as private investment brought more machines into the province, and waiting times would fall or even disappear as more care was provided for the same amount of money already being paid for health care. Such changes would also mean that taxpayers would finally see value for the money that they have been paying into health care for years.

The Saskatchewan health care system has the potential and more than adequate resources to serve patients and meet the demand for health care, but realizing that potential will require change. Until that change comes, patients will continue to languish on the province’s waiting lists and their surgeries will continue to be pushed off to maintain budgetary limits.