WAITING LISTS
Cannot Be Ignored

Can positive thinking really help people live longer and healthier lives?

It’s hard to tell, but if warm, fuzzy thoughts are the key to longevity, it seems many of Canada’s health care experts are well on their way to joining the Centenarian’s Club.

Consider, for example, a recent article by Professors Bob Evans, one of the country’s most prominent health economists, and Noralau Roos, chair of a major health care research centre.

In the piece, Evans and Roos argue that Canadians are just too darn negative. Our health care system isn’t just good, it’s “one of the world’s most successful.” And while we harp on the bad news, “there is no shortage of good news.” Canadians, they remind us, have a long life expectancy, low infant mortality and yet pay less than Americans for health care.

It’s not that there is anything untrue about these statements. Yes, Canadian statistics on life expectancy and infant mortality are pretty good—but this is largely due to basic sanitation and peaceful times. And Canadians do, in fact, spend less on health care than their American neighbours—though American expenditures are inflated by their higher spending on research, their punitive legal system, and the socioeconomic problems of their inner-cities.

But all their “good news” and comparisons to the US miss the point. In their eagerness to gloat about Canada’s health care system, they fail to recognize its significant shortcomings. Indeed, Evans and Roos minimize these problems. Perhaps more troubling, they are not alone.

Waiting lists, for instance, have been increasingly in the news as of late.

Many doctors have publicly complained that treatment effectiveness can be undermined by the delays. But Evans and Roos basically dismiss the concern. “Claims of excessive waiting lists,” they write, “are the ‘political theatre’ of publicly funded health care everywhere in the world.”

These views may seem shockingly out of the mainstream—but, in health care policy circles, they are the norm. At a recent conference, a well-known epidemiologist received applause when he explained: “the waiting list problem is greatly exaggerated and distorted.”

Carleton professors Pat and Hugh Armstrong write in their book Universal Health Care: What the United States Can Learn from the Canadian Experience, “Canadians do not wait for care that is required immediately” (p. 55).

A study of waiting lists by a government-financed centre begins by saying: “it is an area where there is far more rhetoric than reality.” There is, however, a body of anecdotal evidence that waiting lists are more than merely “political theatre.”

My own views on waiting lists have been darkly coloured by the experiences of a few family friends: a young Winnipeg woman with severe abdominal pain was expected to wait six months for the pain-alleviating gall bladder surgery; a community college teacher from southern Ontario suffered heart trouble and was forced to take a year off work while he waited for the bypass surgery; an older woman with severe sleeping problems was put on a two-year waiting list to see a respiratory specialist.

If such anecdotal evidence seems unconvincing, the limited statistical analysis on waiting times is hardly encouraging. A study recently published in the Canadian Medical Association Journal on cardiac surgery in Newfoundland found that of the roughly 150 patients who required “very urgent” or “urgent” surgery, fewer than one in four got the operation within the clinically recommended period.

A study comparing hip and knee surgeries in Boston and Montreal found that although Canadian patients had more expensive rehabilitation, they fared worse in the long term because surgery was often performed late in the natural history of the disease.

In July, a national newspaper contacted six provincial cancer agencies and asked about waiting times. The Canadian Association of Radiation Oncologists recommends that a cancer patient wait no longer than two weeks to see an oncologist (a cancer specialist) after referral and no longer than two weeks to begin radiation therapy after seeing an oncologist. In every province, the average patient waited longer, except in emergency cases. In Ontario, two thirds of patients wait up to eight weeks to begin radiation therapy.

And there are other studies: on hip replacement (Ontario), bladder cancer survival (Nova Scotia), bypass surgery (Quebec)—each one suggesting patients wait too long. The available information suggests waiting lists are not only forcing many patients to suffer physical pain, but possibly even jeopardizing their health. The issue, then, deserves more than the flippant dismissal that Evans and Roos offer.

With such a body of evidence, why is it experts are so quick to overlook waiting lists and focus in on the “good news?” And why are these same experts so intolerant of differing views, questioning the motivation and patriotism of Medicare’s critics?

Perhaps the answer lies in the nature of the problem. Waiting lists do not represent a modest organizational issue. Waiting lists stem from the very nature of our health care system. With all services being free, Canadians see too many doctors, request too many tests, and stay in hospitals too long. To combat these expenses, provincial governments control costs by rationing health services—everything is still free, you just have to wait.

The experts realize such rationing is unpopular but essential to the stability of our health care system. Canadians, then, have a choice: they can ignore the growing waiting lists and participate in the positive thinking exercises of their health care experts, or they can set out to establish a better health care system.

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Last Modified: Wednesday, October 20, 1999.