Waiting Longer-Than-Advised for Health Care Costs Economy $14.8 Billion: CMA

By Helen Branswell, Medical Reporter, THE CANADIAN PRESS

TORONTO – Lengthy waiting times for four key health-care services cost the Canadian economy $14.8 billion last year in lost productivity and added health expenses, a report released Tuesday suggests.

That reduction in economic activity in turn cost federal and provincial governments $4.4 billion in lost tax revenues, added the report, written for the Canadian Medical Association by the Centre for Spatial Economics.

CMA president Dr. Brian Day said the figures represent a failing of the health-care system.

“We knew not only are the patients suffering, and not only are the patients experiencing chronic discomfort, but there’s a cost. An economic cost,” Day said in an interview.

“And we wanted to convince governments that it didn’t make economic sense to use rationing as a way of not spending the money to treat patients – that it actually ends up costing more.”

The report met with skepticism in some quarters, with several observers describing it as the latest salvo in a campaign by Day – an orthopedic surgeon who owns a private surgery clinic in Vancouver – to generate support for private health-care options.

“Dr. Day’s agenda is to show that the public system is hopeless, that it can’t possibly meet legitimate need and that the only solution is to set up and allow and fund a private parallel system – some of it with public funding, some of it without public funding,” said Steven Lewis, an independent health-policy analyst who also teaches at the University of Calgary’s Centre for Health and Policy Studies.

Dr. Robert Evans, a leading health economist with the Centre for Health Services and Policy Research at the University of British Columbia, noted that the medical association’s position on health-care spending comes with a built-in vested interest.

“Every dollar we put into this system becomes a dollar of somebody’s income,” Evans said.

“When the CMA comes out saying that ‘Our system is underfunded and we desperately need more of this, that and the other thing’ . . . we have to remember that they are a trade association representing doctors.”

“They are not a public service agency representing patients.”

Day said the study is an attempt to put dollar figures on what doctors have been seeing for years – the toll patients and society pay for delays in access to needed health-care services.

It looks only at four procedures which were among five so-called priority areas targeted for wait-time reductions following the 2003 First Ministers’ Accord on Health Care: total joint replacement surgery, cataract surgery, coronary artery bypass graft and MRI scans.

The fifth, radiation therapy, was excluded from the analysis because of a lack of comparable data from all provinces.

The authors of the study calculated the cost of having people wait longer than the maximum recommended wait time set out for these services, for instance 30 days for an MRI or 42 days for bypass surgery. The wait time clock only starts ticking from the time a patient sees a specialist and doesn’t include the time it takes to get an appointment with a specialist.

Because of that, and the fact the report doesn’t cost out expenses associated with waiting for myriad other services and procedures, Day described the cost estimates as conservative.

Costs factored into the figures included lost productivity of workers waiting for care, lost productivity of family members who have to stay home or cut back their hours to care for the waiting patient and additional health-care services needed because of physical deterioration caused by the delay in receiving care.

The per-patient costs ranged from a high of $33,400 for joint replacement in Alberta – where the labour shortage drives up the value of lost productivity – to a low of $1,700 for cataract surgery in Saskatchewan.

The report does not calculate how much more governments would have to invest in the health-care system to bring waiting times for these services in line with the medically recommended maximums.

But Day insisted it would be cheaper to reduce the waiting times than to keep the status quo, arguing that a number of countries with universal care programs do not have wait time problems like Canada’s.

The bulk of the calculated costs – $13.8 billion in fact – are blamed on excessive waits for MRI scans.

Lewis suggested a basic premise of the report – that all the ordered procedures are medically necessary – can’t be assumed to be true when it comes to MRIs. He noted there has been a five-fold increase in the number of MRIs performed in Canada over the last decade or so, but with no real effort to assess whether Canadians are healthier for it.

“It’s not just under-service that costs the economy; so does useless and wasteful service,” he said.

And Evans argued that experience shows that if governments ante up even more funds to attack waiting times, the problem probably won’t go away.

“Waiting lists in these areas have developed and persisted despite dramatic increases in the rate of performance of these procedures, simply because as you add more capacity clinicians put more people on the list,” he said from Vancouver.

“That will continue. Absolutely.”