Moir and Barua • Waiting Your Turn: 2023 Report • iii fraserinstitute.org Canada Newfoundland & Labrador Prince Edward Island Nova Scotia New Brunswick Quebec Ontario Manitoba Saskatchewan Alberta British Columbia . . . . . . . . . . . . . . . . . . . . . . Weeks waited Median wait from referral by GP to treatment, by province, 1993 and 2023 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Note: Totals may not equal the sum of subtotals as a result of rounding. Sources: The Fraser Institute’s national waiting list survey, 2023; Waiting Your Turn, 1997. specialist to treatment GP to specialist specialist to treatment GP to specialist Waiting costs money Commenting on their findings, Waiting Your Turn study authors Moir and Barua emphasize that “Wait times can, and do have serious consequences well beyond benign inconveniences…as they (can generate) increased pain, suffering and mental anguish. In certain instances, they can also result in poorer medical outcomes – transforming potentially reversible illnesses or injuries into chronic, irreversible conditions, or even permanent disabilities.” In addition, “Patients may also have to forgo their wages while they wait for treatment, resulting in an economic cost to…themselves and the economy in general.” Moir and Barua also estimated the cost of waiting per patient in Canada to be approximately $2,925 in 2022 if only normal working hours were calculated. But if all waking hours during the normal working week were considered lost, the cost per patient would be $8,897. As Moir and Barua estimated, 1,209,194 Canadians joined waiting list lineups in 2023. Assuming that each patient waited for only one procedure, this means that 3.0 per cent of all Canadians waited in line for medically necessary treatment services during 2023. That varied from a low of 2.14% of the population of Ontario to a high of 8.39% of Nova Scotians. In addition, this year’s survey of specialists also found that an estimated 1.8% of patients left the country to avoid the lengthening waits. Clearly, those costs would be substantial. Health So, what’s a reasonable wait? Moir and Barua explain that determining “reasonable” wait times nationally is complicated by the fact that provincial health-care agencies or professional associations often differ in the way in which they measure wait times; some do so from the point at which a patient is referred by a GP to a specialist, others only start their clocks when the operating room is booked. And even though provincial and federal governments agreed on benchmarks for necessary treatments in 2005, more than 50 per cent of patients in some provinces had already waited for longer than what their governments considered “reasonable.” Defining “reasonable” is a slippery slope. In a paper published by the Canadian College of Family Physicians in 2020*, a study group of family physicians recommended setting a maximum six-month wait time benchmark for all non-urgent referrals in Canada, a suggestion which aligned with the Canadian Medical Protective Association’s recommendation. It further noted that, “Long wait times have become a defining characteristic of Canadian health care” and cited a prominent Commonwealth Fund ranking that listed Canada “last” in controlling specialist care wait times among 11 high-income, developed OECD countries, among them The Netherlands, Switzerland, Germany, Australia and France – despite the fact that Canada spent more on health care (in 2023) than almost all other nations (Switzerland is the exception) which have universal health-care regimes. *How long are Canadians waiting to access specialty care. Canadian Family Physician. Vol 66. June 2020. However, in determining “reasonableness” for Waiting Your Turn 2023, Moir and Barua turned to the specialists in their survey to establish what they felt were “reasonable” wait times. For orthopedic surgery, which carries the longest listed wait time (28.9 weeks), the surveyed specialists’ responses set 13.3 weeks as “reasonable.” They also designated five weeks as a “reasonable” timeline for internal medicine (instead of the actual 13.2 weeks); 7.3 weeks instead of 10 for general surgery; and 6.2 for neurosurgery instead of the actual 12.5 weeks. Their scores confirmed that radiation and medical oncology, as well as cardiovascular surgery (both urgent and elective) were already within a few points of each other. Overall, their collective responses settled on a weighted median target of 8.5 weeks for 14 of the most common specialty procedures currently absorbing 13.1 weeks of waiting time. And though there was a wide divergence among individual provinces, Ontario came closest to meeting the “reasonable” standard for wait times, scoring an “actual” 7.3 compared to the “reasonable” 8.5 weeks. Waiting Your Turn also contained an appendix covering referrals and wait times for psychiatric care that revealed significant differentials in availability among provinces, but more so in Atlantic Canada than elsewhere. In Canada as a whole, total wait time (from referral by a general practitioner to the start of psychiatric treatment was 27.6 weeks. In central and western provinces, that time ranged from a low of 17 weeks in Alberta to a high of 42.2 weeks in Manitoba. Ontario and Quebec ranged from 28.9 to 26.3, respectively. But in New Brunswick, that overall wait soared to 93.8 weeks and from Prince Edward Island and Newfoundland and Labrador, there were no data at all, while Nova Scotia clocked in at 42.3 weeks. Summing up Once again, as in the past 30 years, wait times for medically necessary services climb and climb. The trajectory hasn’t changed. But the bottom line, as calculated in this annual report, remains constant: “It is clear that patients in Canada wait too long to receive medically necessary treatment.” CSANews | SPRING 2024 | 35
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