By Nadeem Esmail and Bacchus Barua, The Fraser Institute
Get ready for Medicare’s annual summer slowdown, where the forecast calls for possibly poorer than usual service levels.
Every year, provincial health care systems across Canada dutifully reduce the volume of services they provide in preparation for the summer vacation season. This planned-for reduction has the inevitable effect of lengthening waiting times for Canadians over the summer months (and during Christmas holidays). The added twist this year is the slowdowns might be extended in a bid to reduce expenditures.
This may be shocking to Canadians expecting Medicare to work as hard and fast as possible to care for patients who typically endure significant delays.
However, surgical suites/operating rooms across Canada including in Alberta, Ontario, PEI, Nova Scotia, and BC, either slow operations or close entirely during the holiday season, at least in part to accommodate vacations.
Of course, health workers should have the opportunity to take vacations and no doubt would like to do so at the same time as other members of their family. So why aren’t additional resources employed to cover for these vacations and avoid slowdowns?
It seems that cost pressures are the primary driver, where the slowdown not only provides space for vacations but also provides some budgetary savings.
And it seems the budgetary benefits of slowdowns may be employed in at least one province to fund other areas, programs, services, and strategies.
Specifically, Alberta’s six week closure for many surgical suites may be increased to 10 weeks partly in order to fund community and emergency care. One wonders how long it will be before other provinces that also want to limit spending growth in health care also extend the summer slowdown season for patients.
That reduction in expenditures comes however at the cost of increased pain, suffering, mental anguish, lost productivity at work and leisure, and strained personal relationships for those who would now have to wait a little longer. And the savings may not be as large as they first seem. After all, people who wait for medical care sometimes need more care (and pharmaceuticals) to help manage their condition and pain while they wait for treatment.
It doesn’t have to be this way. Canadians don’t need to trade off pain and suffering for limited growth in health expenditures. Canadians don’t need to trade off pain and suffering for those waiting for surgery so that those in the community and those in a state of emergency can get their care. And health workers don’t have to scrap their summer vacation plans.
Consider that Canada maintains one of the developed world’s most expensive universal access health care systems on an age-adjusted basis. And at the same time, Canadian wait times for access to emergency care, primary care, specialist consultations, and elective surgery are among the longest in the developed world. That combination suggests Canada’s governments are doing something very wrong in health care.
Indeed, several developed nations maintain universal access health care systems without problematic wait times. Belgium, France, Germany, Japan, Luxembourg, the Netherlands, and Switzerland all provide access to care regardless of ability to pay. Unlike Canada however, they all provide that access when care is required, rather than when a bureaucratic government monopoly is willing to deliver it.
Such performance does not come at increased cost; all of these nations spend less than we do on health care. Rather, it results from a greater reliance on private health care providers, private health care financing, and activity-based funding.
By doing things differently than we do, and in particular ignoring the ‘private’ and ‘profit’ boogeymen, these nations provide far superior access to health care more efficiently than Canada’s provincial governments.
With the absence of problematic waiting lists, things like slowdowns for holidays and staff vacations cease to become a matter of concern to patients and the public. Nurses and doctors take holidays, patients get timely care, and payers don’t get stuck with an oversized bill.
In the meantime, thanks to ill-conceived policy, Canadians will yet again endure a summer season that stretches their wait times for medical treatment.
And signs suggest things may worsen in coming years as governments seek to limit expenditure growth while juggling various health system initiatives and activities. It needn’t be this way: more sensible approaches to health care policy could improve timeliness without increasing expenditures, all while allowing health care providers a little time off during the holiday season.
Nadeem Esmail is director of health policy studies at the Fraser Institute. Bacchus Barua is a Fraser Institute economist.