Since 1947, Canada has taken pride in its publicly funded, universal health care system and has successfully provided exceptional health care to all Canadian citizens. Founded by Tommy Douglas, the Medicare system, eventually leading to the Canadian Health Act of 1984, paved the way for today’s health care system in Canada (Bryant, 2010). Boasting free health care coverage to every Canadian, the Canadian Health Act promises more than it can realistically live up to. As times continue to change, pressures to do more plague the Canadian health care system in spite of slower rates of advancement and expansion in resources. Diminishing access to care, increased numbers of patients, and intolerable wait times are some examples of issues that have been of high concern to the government and general public.
For years, tedious waiting times have become a deepening rift in Canada’s health care system. A waiting list commonly refers to a roster of people in need of medical attention who are pending a specific service. In theory, they are present when the demand for specific medical attention exceeds the instantly available supply (Mcdonald et al, 1998). With minor exceptions, Canadian waiting lists, like most countries, are non-regulated, generally unsupervised, and in dire need of reform. Specialized treatments, surgeries and many other procedures that do not fall under the category of “medically necessary” are commonly pushed to the side while cases that require immediate attention take precedence (Bryant, 2010).
What follows is a discussion of the shortcomings of the current Canadian Healthcare system. These issues continue to emerge as a major blemish in the Canadian system. Namely, a lack of doctors, uneven distribution of health care practitioners between and within provinces, and the non-standardization of wait lists have had significant impacts on Canadian wait times, ultimately risking adaptation to a private health care system. By standardizing wait lists, managing them efficiently and increasing resources and funding, Canada will pave the way for a better future in health care infrastructure.
Importance of Wait Lists in Canada
In a country where health care is predominately funded by the public, wait lists are an essential component. If Canada employed a system where there
was no such thing as wait lists, many doctors, facilities, and equipment would be inoperative for long times due to the fact that the new system would face “peak load” demands (Barer and Lewis, 2000). Disregarding the immense costs necessary to fund this system, we would also prevent the doctors and buildings invested in this type of system from benefitting from the health care system in other, more productive ways. If properly created, monitored and coordinated wait lists can serve as very useful tools in managing Canadian Health Care. They serve as mediums to get patients to appropriate resources, organized by their degree of urgency/priority. In addition, they give patients time for second-thought, and ensure that people, equipment and facilities are used efficiently (Barer and Lewis, 2000).
Unequal Distribution of Physicians and Nurses within Canada
Although Health Care in Canada is universal, it is often not the cost of the procedure that hinders a person from seeking care, but difficulty to access. Despite given the ability to afford health care, availability of health care is not always guaranteed. Often, doctor’s are based in more urban areas of the country, causing accessibility problems for those residing in rural areas or areas with a very low population density (Bryant, 2010). Health care dollars are distributed according to provincial demographics, which means that rural areas often receive less funding than densely populated metropolitan areas. Critics complain that as a result, rural health facilities are improved at a slower rate, and that the lack of dollars in the rural areas results in a shortage of doctors, nurses and specialists (Bryant, 2010). Rural residents often have to travel long distances to see specialists within their health care districts, or because doctor’s in their region do not have the necessary equipment to undergo specific checkups.
It is a recurring trend that Canadian doctors move to the United States to work, fuelling what we call “Brain Drain”. Studies show that one in nine Canadian trained doctors have reported to be practising medicine in the United States. (Barer, 2000). It was estimated by The American Medical Association that around 9,800 graduates from Canadian medical schools are currently functioning doctors in the United States, seeking better pay and better graduate school opportunities (CIHI, 2007). This exodus of Canadian doctors to the United States has increased Canada’s growing shortage of medical staff leaving over 4000 citizens without a family doctor, especially in rural areas. Solutions being implemented in Canada to reduce wait times
At the federal level, the government has funded research on wait times, established a six-year $4.5 billion Wait Times Reduction Fund, and appointed a Federal Advisor on Wait Times (CIHI, 2006). Like many other countries, Canada has been following the trend of simply putting billions of dollars to bring about reform. However, this money merely serves as a quick fix to these issues, disregarding the underlying structural problems that brought about these issues to begin with.. A fine example is the development of the Cardiac Care Network (CCN) in Ontario (French et al, 1990). It links twelve surgical offices that are each coordinated by a nurse from the centre.
What SHOULD be done- Standardization of the System
Standardized systems should be employed to calculate and report wait times in order to verify whether or not a patient should be put on a wait list. This includes ensuring that the patient is in line for the right procedure and that they are continuously monitored to make certain that they are fittingly prioritized according to their present condition (Mcdonald et al, 1998). It is essential that patients be prioritized and appropriately allocated resources until their procedure in order to fairly and rightfully provide medical services. Standardization should also consider and measure the clinical severity of patients to ensure that the patient has a high potential to benefit from the procedure, rather than to be in a more detrimental condition. In addition, methods to remove patients who no longer need to be on the lists, or those who would like to opt out of the procedure should be employed.
Management and Liability
In order to prevent inappropriate use of wait lists, mechanisms should be engaged to hold clinicians responsible for placing and prioritizing their patients fairly on lists. At the regional level, methods of collaborating and prioritizing lists across institutions should be developed to provide a continuous database of physician and patient information (Mcdonald et al, 1998). Presently, wait lists among physicians are monitored individually and there is little to no communication among physicians about wait lists, except in rare cases such as the case of the aforementioned Cardiac Care Network. In order to fine-tune this mechanism, periodic audits should be put in place.
These methods will allow for doctors with a high volume of patients to transfer their patients to physicians with more availability in order to provide the service to the patient quicker, or to get the patient a more specific procedure according to their need (Mcdonald et al, 1998). In addition to provincial and regional databases, cross-provincial or nationwide databases should be put in place for abnormal circumstances where volumes are too high to service. Resources and Investment
The development of criteria for standardization, monitoring, regulating and auditing wait lists, and the creation of shared databases all demonstrate the need for a substantial investment of time and money towards the improvement of wait list infrastructure (Mulcahy et al, 2010). It is impossible to expect the aforementioned mechanisms and methods to materialize without a dedication of time and funding from individuals and at the federal, provincial and regional levels alike. In addition, there is a need to develop widely accepted criteria to determine when a wait list may require attention, for example, when all mechanisms are being followed correctly, but wait times are still unacceptable(Mcdonald et al, 1998). In these circumstances, jurisdictions should be prearranged to vigilantly target funding to re-establish suitable wait times.
It is often suggested that creating a parallel private health care system allows for private services to work in conjunction with publicly funded systems. This will allow those who are able to afford private health care to pay for their services, which some may assume will ultimately decrease the wait times in the public sector. According to a study by The Canadian Health Services Research Foundation (CHSRF) a substantial amount of evidence advocates that a parallel, two-tier system will not reduce public waiting times and therefore will not serve as a solution to our current wait time issue (Mulcahy et al, 2010). In fact, it is reported to lengthen wait times in the public sector due to public loss of doctors to the private sector. The private system will thus simply provide more rapid attention to those with higher incomes and further compromise access to care for patients waiting in the public system (Mulcahy et al, 2010).
Although Canadians have fewer financial barriers to access health care than our neighbours to the south, it is evident that this does not guarantee equality in actual usage (Bryant, 2010). Inequitable distribution of access, extremely long waiting lists, and doctor shortages plague Canada more than ever before. Residents living in isolated areas and the poor receive less adequate health care in comparison to those in populated areas (Bryant, 2010). Although it seems that adapting to a two-tier parallel private system will be a valuable solution to these issues, studies have proven otherwise. So what’s next for Canada? Will increasing taxes and putting more money into the system solve all of our problems? Research proves that it isn’t all about the money. It is also important to efficiently target resources, which will require a high level of commitment from all levels of governance.
While the federal government can take part in assisting the formation of standards and criteria in Canadian health care, funding important research to bring about change, and constructing registries for wait lists nationwide, those at the provincial and regional levels will guarantee effective and acceptable use of wait lists to confirm that there is sufficient access to resources (Mcdonald et al, 1998). Although Canada is obviously in desperate need of reform, it is without a doubt that change is within our bounds. With organization, improved coordination, better access and team work, our nation has full capability of amending the system , without neglecting Canadian philosophy.
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Bryant, B.E. (1981) Issues on the distribution of health care: some lessons from Canada. Public Health Reports, 96(5): 442–447.
Bryant, T., Raphael, D., Rioux, M. (2010) Staying Alive. Critical Perspectives on Health, Illness, and Health Care. (pp. 65-73) Toronto, ON: Canadian Scholars’ Press Inc.
CIHI (2006) Waiting for Health Care in Canada: What We Know and What We Don’t Know. (pp. 2-37) Ottawa, Ontario: Canadian Institute for Health Information.
French J.A., Stevenson C.H., Eglinton J., Bailey J.E. (1990) Effect of information about waiting lists on referral patterns of general practitioners. The British Journal of General Practice . 40(334), 186–189.
McDonald, P., Shortt, S., Sanmartin, C., Barer, M., Lewis, S., Sheps, S. (1998) Waiting Lists and Waiting Times for Health Care in Canada: More Management! More Money? (pp. 1-17) Ottawa: Health Canada.
Mulcahy, C.M., Parry, D.C., Glover, T.D. (2010) The “Patient Patient”: The Trauma of Waiting and the Power of Resistance for People Living With Cancer. Qualitative Health Research, 20(8), 1062–1075.