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How to bring accountability to health care

The ProfessorBy Steven Martinovich

(April 26, 2004) A good clue that an election call is just around the corner, particularly with the Martin government suffering through its Adscam scandal which featured a lack of it, is when cabinet minister begins publicly discussing accountability to Canadians. Last Tuesday during a conference on health reform, Health Minister Pierre Pettigrew used his first major speech since being named to the portfolio to address just that topic.

Pettigrew stated that provincial governments should announce appropriate wait times for medical services and regularly report how well they are meeting those standards.

"Canadians have a right to know what acceptable wait times are for different types of services and procedures, what level of care they should expect, whether their local providers are doing better or worse than the norm, and why."

On the face of it Pettigrew's call for more accountability when it comes to wait times is laudable. Across the entire health care system Canadians often face excruciating waits for everything from simple doctors appointments, diagnosis, specialists and ultimately treatment. Unfortunately, merely setting national standards won't be enough to reduce wait times. It is the nature of the system itself that creates wait times, not the lack of national standards.

Government-run single-payer systems by definition are less efficient than their private-sector counterparts as Canadians can testify. The Fraser Institute releases an annual survey of waiting times for common procedures and each year the wait is longer. Total waiting time between referral from a general practitioner and treatment, averaged across 12 specialties and 10 provinces surveyed, rose from 16.2 weeks in 2000-01 to 17.7 weeks in 2003.

According to health policy analyst Nadeem Esmail, "In 2003, actual waiting times for medical services in Canada exceeded the times physicians felt were clinically 'reasonable' in 92 percent of the 12 medical specialties and 10 provinces surveyed." This occurs despite the fact that the Canadian health care system is tied with Iceland as the most expensive universal access system in the OECD on an age-adjusted basis

Canadians will be surprised to learn that wait times have also been built into the system intentionally. In a recent London Free Press editorial Dr. Gordon Guyatt, who defends the current system, argued that wait times are necessary because they allow doctors to prioritize patients and decide what services they really need. Without wait times, the argument goes, doctors and patients would bankrupt the system by utilizing discretionary and diagnostic services in a negligent manner. That will doubtless come as little comfort to Canadians waiting for several months for treatment.

The reason why the Canadian health care system is in such dire straits isn't a mystery. Due to the utter lack of free market discipline, our single-payer system is under no pressure to find efficiencies, acquire new equipment, introduce new treatments and keep costs down. Although Canada spends about as much as a percentage of GDP on health care as the United States -- once money spent on research is factored out -- the system finds itself increasingly unable to focus its resources where they are needed most.

If Pettigrew really wishes to inject some accountability into the nation's health care system, he should consider free market reforms. As Esmail argued recently, one of those reforms should be cost sharing. Patients who are responsible for some of the cost -- those with low-incomes would be exempted -- end up making more informed decisions about when and where the system is accessed. "In such a system, where patients access services less frequently than when it is free at the point of access (as in Canada), long waiting times would no longer be necessary to manage demand," he writes.

Shoveling more money into the system or importing health care professionals from other countries won't lead to permanently reduced wait times, they are actions that merely ameliorate the situation in the short-term. The secret to real accountability is to make the system answerable not to ministers of health, but the people who rely on it every day.

Thanks for reading,

Steven Martinovich


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