Cost of waiting for care a multibillion-dollar scandal: CMA
The length of time patients wait for care in just four areas - joint replacement, sight restoration, cardiac bypass surgery and MRI scans - cost Canada $14.8 billion last year and lowered government revenues by $4.4 billion during the same period.
The information, from a study done for the CMA by the Centre for Spatial Economics, was released in Toronto during a Jan. 15 speech by President Brian Day. The totals are based on factors such as patients' inability to work or work productively while awaiting care.
"Our estimates are extremely conservative," Day told the Economic Club of Toronto. "They address only the wait time to treatment after a specialist's consultation and recommendation, and they exclude the growing and significant costs of waiting to see the family doctor or specialist.
". . . Moreover, they do not include the costs, short and long term, of the deterioration that occurs while waiting. I want you to imagine the costs if all of these were included in all areas of clinical care. As an orthopedic surgeon, I have seen patients develop chronic and severe, irreversible damage, addiction to painkillers, and depression.
"And it need not happen."
Day's speech was part of the CMA's ongoing assault on wait times and other access-to-care issues, and he pulled no punches. He described lengthy wait times as "a curse on the economy and our country" before adding: "Forcing patients to endure pain and suffering in order to sustain a social program is wrong."
The speech looked back at the causes of today's wait-time problems and looked ahead to the steps that can be taken to solve them. He said the causes include ill-advised decisions to cut medical school enrolments in the early 1990s, politicians' assumption that health care "is immune from all accepted economic principles" and "self-serving" steps by some groups to protect the status quo at all costs.
On Jan. 15, the CMA turned all of its guns on that same status quo, with Day arguing that the economic costs and financial liabilities of waiting patients are unfunded liabilities on Canada's governments that should be included in annual budgets. "A rich country like Canada should not keep so many patients waiting for so long," he said.
To eliminate wait times, Day said investment is needed in five areas:
- preventive care and health promotion, with more emphasis on self-responsibility and patient-consumer empowerment;
- patient-focused care, productivity and excellence;
- innovation and technology;
- the repatriation of Canadian physicians who have moved to the US and elsewhere, and retention of the doctors and medical students who are here;
- training more health care workers.
"Note that I say invest, not spend," said Day. "These investments will realize substantial returns as wait lists are progressively eliminated."
He said a switch to patient-focused funding is crucial for Canada's hospitals because this will provide incentives to improve productivity that are not possible under the current block-funding system by which they receive "annual global budgets that are largely independent of efficiency or productivity."
At the same time, a focus on investment in information technology will pay huge dividends because it will streamline care and reduce the number of avoidable adverse effects.
Day then switched his attention to human resources, pointing out that today Canada has fallen to 24th among OECD countries in terms of physicians per capita after ranking fourth in 1970. "How many of you have a doctor who is 50 or older? Who do you think will look after you when you are older and need medical attention?"
And for Canada to reach the OECD average of three physicians per 1,000 population, it would need to add 26,000 physicians - more than 10 years' output from its 17 medical schools - at once.
"It is a disgrace that half of all newly trained orthopedic surgeons and neurosurgeons leave Canada within five years of graduation," he said. ". . . Between 1991 and 2004, the equivalent of two full medical schools' graduating classes left Canada each year. They leave because of a system that encompasses rationing and restricted access, leading to the peculiar paradox of a doctor exodus in times of a doctor shortage."
Day concluded that he, and the medical profession, have a responsibility to speak out on behalf of their patients.
"It is not our role as physicians to passively accept the prolonged suffering of patients.", he said. "We want to manage patients, not wait lists."
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© Canadian Medical Association or its licensors 2008
