POLICY/INTERNATIONAL: Canadians somewhat grumpy about waiting, but not waiting that long

How bad are those terrible waiting lists in Canada? Well if you hang with the loonies at Fraser and PRI they average 10 months for a typical pregnancy and care for everyone else is delivered only by morticians. On the other hand, StatCanada (the official government body, and this one I believe is an independent bunch of civil servants rather than the US variety who’s reports are re-written by 23 yr old Republican staffers) is out with some real data.

What’s the conclusion? Canadians have to wait a little bit, and they’re pissed off, but only a little bit

Results for 2005 indicate that waiting for care remains the number one barrier for those having difficulties accessing care. Median waiting times for all specialized services have remained relatively stable between 2003 and 2005 at 3 to 4 weeks, depending on the type of care. There were some differences noted in selected provinces. Most individuals continue to report that they received care within 3 months.

Similarly, patients’ views about waiting for care have remained  fairly stable between 2003 and 2005. While 70 to 80 percent indicated that their waiting time was acceptable – there continues to be a proportion of Canadians who feel they are waiting an unacceptably long time for care.

And how bad did that wait make them feel? Well most didn’t seem to worry at all but some were pissed off.

The proportion of patients who felt that their waiting time was unacceptable was highest among those who waited for specialist visits (29%) and diagnostic tests (21%) and lowest among those who waited for non-emergency surgery (16%) (Chart 2 ; Table 9) even though individuals are more likely to wait longer (i.e. > 3 months) for non-emergency surgical care compared with other specialized services (Table 7).

And for some the wait involved real inconvenience and pain. But that was less than 20%.

Approximately 18% of individuals who visited a specialist indicated that waiting for the visit affected their life compared with 11% and 12% for non-emergency surgery and diagnostic tests respectively. (Table 10)

And most of that was stress related rather than actual pain, although there was some of that too with about half experiencing pain. (These are proportions of those who experienced adverse effects from waiting)

Most of those who were affected reported that they experienced worry, stress and anxiety during the waiting period: ranging from 49% among those whose lives were affected by waiting for non-emergency surgery to 71% among those affected by waiting for a diagnostic test. (Table 11) Between 38% and 51% of individuals waiting for specialist services experienced pain and close to 36% of those who were affected by waiting for non-emergency surgery indicated that they experienced difficulties with activities of daily living. Approximately 28% of those who were affected by waiting for a diagnostic test indicated that it resulted in worry, stress and anxiety for their friends and family.

But of course what this doesn’t tell you and what the myopic Canada bashers like Gratzer, the PRI crowd and the AMA guy all fail to point out is the other half of the equation.

Even if every single American never had to wait for any care, there is considerable the impact because of our system on the financial health of poorer Americans, and there is also consequent impact on those poorer Americans’ access to care services. Below is a chart from the 2004 Health Affairs report which shows that on a raft of issues, like not getting care from a doctor, skipping recommended care, and not filing prescriptions, the direct cost of care here impacts people just as much, if not more so. And of course some substantial number of Americans (whichever side of that argument you believe) are going bankrupt because of it.


Yes there are problems with the Canadian system. Yes there’s room for honest debate about it.

But take the veil of ignorance test John Tierney uses in his columns in the NY Times. If you didn’t know you were going to be born or become rich, which system would you rather be in given the realistic chance that you might end up poor? The one that will get to you if you’re prepared to wait a few months, or the one that you won’t ever get to because you can’t afford to, and that might bankrupt you if you really need it? I bet you nearly half Americans would change places if they knew.

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6 replies »

  1. One way the USA can cut costs is by refusing to pay for medical care for old people who are about to die anyways, or for those people in which treatment will only delay the inevitable.
    Canada does not pay for a $25,000 round of chemo for a stage IV disseminated cancer patient who will only live an extra 2 months due to that treatment.
    In contrast, here in the US we pay for EVERYTHING from an end of life standpoint. We pony up 100k just to keep a terminal cancer patient alive for an extra month. Canada and Europe dont tolerate that nonsense.
    In the US, 80% of our healthcare dollars are spent on people who are going to die within 3 months regardless of treatment.
    In Canada/Europe, that percentage is much lower, somewhere around 15-25%.

  2. Frasier there CATO here, yawn. When wait lists for cancer treatment got too bad the Canadian Gov. sent patients to Buffalo, in Ontario where wait lists for cataracts and hip replacements got really bad the gov targeted money to those needs. At least the Canucks are responding to patient needs. One Quebecer sued the health plan because he needed special cancer care only avaiable in U.S. He sued to get his out of pocket money back – and won. Wonder how he would have faired here? If Canadians don’t like how their provincial reps. are handling healthcare they can vote them out, ever tried to vote out an insurance exec. or a hospital CEO? I wonder what the wait list here is for those that don’t have the money to pay for surgery? Or maybe there’s a wait list to see a bankruptcy lawyer, no wait the Repugs made declaring bankruptcy even harder, so you’ll have to lose more of your total assets and get closer to the street. How is this system resonding to patient needs? Seen any changes yet other than continually increasing prices. If the U.S. system tried 1/10th as hard at controling costs as the Canadians we’d be much better off.

  3. One should not take any “statistics” at face value — especially from obscure & self-serving opinion surveys by government bureaucrats. Did you use “extreme caution” interpreting the accuracy of this Canadian survey — as its authors warn you to do (… in their fine-print methodology) ?
    The referenced Canadian study on “Waiting for Health Care” is not even close to being an objective presentation of facts. Again in the fine-print, its authors admit that: “…reliable estimates at the national and provincial levels could not be produced for all the variables..”
    First, that study is based heavily upon a telephone polling … notorious for low response rates (non-random sample) and high process error rates. Its authors claim an overall response rate of 79% on a 33,000+ sample — which is literally incredible; expert professional polling companies (Harris, Pew, etc) rarely approach even a 50% response rate on much smaller sample sizes.
    Secondly, it relies totally upon subjective ‘self-reporting’ by selected patients — and their opinions & recollections as to their perceived health-care experiences and ‘approximate’ wait times.
    Are there no factual records of waiting-times kept in Canadian hospitals & clinics ??
    Why resort to subjective opinion-polling for such information ?
    Thirdly, it ONLY includes persons who “completed their waiting periods and received care”. Data does NOT reflect the waiting times of those still waiting at the time of the survey. Those who gave up waiting and just decided to live with their ailment… or sought care elsewhere — were not included in the results.
    Also, it was specifically limited ONLY to the previous 12 month period — if a patient had been waiting 13 months or more for a surgical procedure that data was EXCLUDED from the calculation of waiting-times. Thus, the entire survey was specifically designed to hide the longest waiting-times experienced by the population.
    The “loonies” at Frasier at least seem more honest & straightforward.
    Why herald this study ??

  4. Care delayed is nearly as bad as care denied, especially in cases where early detection is key. The answer to access problems can be found in the Massachusetts plan, as even Ted Kennedy seems to agree. Why anyone would want to impose a huge unfunded liability on the taxpayer that is being voluntarily handled by the private sector continues to elude me.