Why Are Hospital Wait Times in Canada So Long?

Whenever there is a discussion about healthcare in the United States, it is inevitable that one side would bring up Canada. “Canada has universal healthcare, so why can’t we?”

And it is just as inevitable that the go-to retort would be, “Are you willing to wait for healthcare as long as Canadians do?”

In the public discourse, waiting for treatment has become an immutable characteristic of Canadian healthcare. Even people who have never stepped foot in Canada talk about long wait times that plague Canadian patients.

But how prevalent is this problem? Why are Canadian hospital wait times so long? What’s the pathway to improving the wait problem in healthcare?

These, and more, questions will be answered in today’s article.

What it’s like waiting for healthcare in Canada

When you’re a patient, your entire existence seems to revolve around waiting. You wait in emergency departments, wait to see family physicians, wait for tests, wait for procedures and wait for elective surgeries.

You would be forgiven to think that with all the breakthroughs in medical technology, those wait times would go down. But in reality, Canada has experienced the opposite.

The 2019 Waiting Your Turn report has found that there was a median waiting time of 20.9 weeks from referral from a general practitioner to receipt of treatment.

For reference, in 2018 it was 19.8 weeks and in 1993 it was “just” 9.3 weeks.

On a similar note, wait times for hip and knee replacements in Canada have been increasing since 2015.

If you think it’s only due to the difficulty of the procedures themselves, other aspects of treatments aren’t much better in Canada, time-wise.

For example, the waiting period from referral to consultation with a specialist was recorded at 10.1 weeks in 2019.

It has been calculated that the total number of procedures for which Canadians were waiting in 2019 was 1,062,286. In other words, assuming that each person was waiting for exactly one procedure, 2.9% of Canadians were waiting for treatment in the year of 2019.

You may have noticed that, so far, we’ve only been talking about 2019. That’s because in 2020, coronavirus came in like a wrecking ball and made what was already a drastic situation much worse.

The global COVID-19 pandemic has affected many things in Canada and the world overall, but healthcare, understandably, has been one of the most impacted.

Thousands of elective surgeries were postponed and as a result, wait times in Canada over the next few years are likely to increase even further as hospitals and doctors deal with their backlogs.

One study showed that in 2020, Canadians were waiting for more than 1.2 million medical procedures.

The negative effects of hospital wait times

Long wait times are more than just an inconvenience.

Wait times can have serious physical and mental consequences, such as pain, stress and anxiety.

Worse still, a potentially curable disease can become chronic or untreatable due to a long wait.

By the way, every aspect of patient experience — from confidence in the care provider to perceived service quality — correlates negatively with longer wait times. This dissatisfaction affects not only the patients’ mood, but the working environment in general.

In Canada, long wait times have led to what they now call hallway medicine — a situation where a hospital is so overcrowded that patients are queued in the hallways of emergency rooms.

Needless to say, this leads to negative experience, bad reviews and tarnished reputations of medical professionals and institutions.

The extent of negative consequences from long wait times goes deeper than that — there is an economic cost for patients having to forgo their wages as they wait for treatment.

It has been estimated that wait times cost Canada’s economy $2.1 billion in lost wages and productivity in 2019. That’s about $2,000 per patient.

But even this $2.1 billion figure doesn’t correctly reflect the reality, as it doesn’t take into account non-workweek-hours. If those were counted, the losses would stack up to $6.4-billion cost, or about $5,972 per person.

“This is a conservative estimate [because] it’s only based on the wait between the specialist or treatment. It’s not looking at the 10.1 weeks it usually takes to see a specialist in the first place, which of course could also add to additional economic costs and additional consequences for patients.”

With so much waiting going on it’s not surprising that Canadians made 217,500 trips abroad for healthcare in 2017 alone, paying out-of-pocket to skip the wait.

Why long wait times are a problem in Canada

A common defense of Canada’s wait times — that long waiting is the price for having universal healthcare — loses its impact when we look at other countries with universal healthcare.

In 2016, 18% of Canadians reported waiting four months or longer for elective surgeries. Contrast that with 8% of Australians, 6% of Swiss and 0% (that’s right, ZERO percent) of Germans.

A 2017 Fraser Institute cost-effectiveness analysis showed that although it ranks among the most expensive universal-access healthcare systems in the OECD, Canada ranked below the average for availability and access, and “mixed” for use of resources and quality of performance.

Let’s see why Canadian healthcare is lagging behind when it comes to the duration of waiting.

1. Canada’s restrictions on private healthcare

So why do these countries, if all of them use the same system, have different results? That’s because, first of all, Canada’s universal healthcare has restrictions.

The main difference between those countries and Canada is that the latter does not allow the private sector to pitch in, due to the Canada Health Act (CHA).

By some estimates, roughly 1% of critical medical care in Canada is done outside the public system. In 2005, the Supreme Court even ruled that a Quebec ban on private health care was unconstitutional, as “access to a waiting list is not access to health care.”

Still, “there is technically no blanket federal ban on private healthcare in Canada”. Most provinces in Canada ban private health insurance or put additional restrictions on how much private doctors can charge.

Any physician can decide to go private, provided that they completely opt out of working for the public system. As this is often the least lucrative option available, only a small number of doctors go into the private sector.

As a result, whereas in other countries private healthcare can help handle sudden surges of patients, in Canada public healthcare is left without plan B.

2. Canada’s lack of medical equipment and staff

One of the other main causes for long wait times is that Canada underinvests in equipment and staff. Canada has 35% fewer acute care beds and per capita than the United States.

If we’re talking about MRIs per capita, Canada is doing worse than Turkey, Chile or even Latvia. In Canada, MRIs have waits that average over nine weeks.

Even ultrasound, which is a routine procedure, have almost four-week waiting lists in Canada.

According to the OECD, Canada ranks 29th out of 33 high-income countries in terms of doctors per 1,000 population. In terms of specialist doctors per capita, Canada has only half as many as the United States.

Another nuance of Canada’s healthcare system is that it’s not a single organism: it is broken up into pieces, with a different health plan, coverages and access to resources for every province and territory.

There is no federal healthcare system in place, and so the same treatment, consultation, surgery or test may take longer, depending on the province.

3. Canada’s underinvestment in wait management technology

Then there’s the issue of inadequate integration of technology. A lot of hospitals still manage paper-based waitlists, which leads to gross inefficiency.

Anecdotally, the amount of administrative paperwork has increased over the years. The additional burden on administrative staff leads to a decrease in the time allotted to treating or managing patients.

This also often leads to mistakes in communication. A third of referrals do not make it to specialists due to mishandling of cases.

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In the article How can Canada improve worsening wait times, family physician Dr. Kamila Premji, cardiologist Dr. Chris Simpson and cancer patient Robin McGee discuss the ways to improve the wait time situation in Canada.

Dr. Simpson argues that a single-entry model would help improve efficiency by 20-30%. Single-entry models address the wait time problem by creating a single queue that directs each patient to the next available provider based on their acuity and priority in the queue.

Dr. Premji states that “being able to see the estimated wait time for each specialist or having a centralized queue” would at least partly solve the problem. Team-based care could also improve the situation: treatment may not be provided by the first specialist the patient meets, but by another physician who is equally skilled and equipped to take on the case.

Finally, McGee says Canadian healthcare institutions need to “empower patients with information”. In case of a delay, there’s often no justification or even communication, and as a result, patients feel as though doctors do not care about their wellbeing.