Ignoring proven wait list solutions undermines health care sustainability

June 6, 2008

Imagine looking in a mirror and not seeing the nose on your face. There it is, right in front of your eyes but somehow you just don’t see it. Sound impossible? Clearly, for some people it’s not because when it comes to health care, our provincial government is expert at ignoring the obvious. Despite a government-initiated, $10 million, year-long “conversation” that saw citizens overwhelmingly call for improvements to publicly-funded health care, the B.C. health ministry shows no signs of listening. To the contrary, the latest provincial health budget sends disturbing signals that more private care is coming down the pipe.

Also seemingly blind is Canadian Medical Association president Dr. Brian Day, although his myopia may be a complication of the fact that he is also president and CEO of Cambie Surgeries Corporation and past-president of the Canadian Independent Medical Clinics Association. Whatever the reason, when presented with proven public solutions to health care wait lists, both Dr. Day and Health Minister George Abbot appear blinkered.

Day recently told a Vancouver Board of Trade audience that the only way to reduce medical waiting lists is to allow the private sector to compete for patients in the public system. Not true. That conclusion flies in the face of solid evidence not only from England, the United States and other foreign countries but, more importantly, from our own backyard.

A year ago, we released a study looking at five groundbreaking projects in BC and three successful initiatives in Alberta, Saskatchewan and Ontario that dramatically reduced waiting times for surgery. Why Wait? Public Solutions to Cure Surgical Wait Lists was a submission to the BC government’s Conversation on Health.

The projects we profiled included the Richmond Hip and Knee Reconstruction project, where median wait times plummeted by up to 75 per cent; Lion’s Gate Hospital’s Joint Replacement Access Clinic, where most patients saw wait times fall from up to two years to four weeks; and Mt. St. Joseph’s Cataract and Corneal Transplant Unit, which cut wait times in half.

These and other projects incorporated one or both of two key changes. First, they used team-based care where surgeons moved from working mainly on their own to working in teams in specialized clinics, and where nurses and other health care workers became more involved in every stage of the process. And second, they shifted responsibility for managing waitlists from individual surgeons to health authorities so that patients could access the first surgeon available.

Their success puts the lie to the assertion that only the private sector can operate efficiently. The good news is that a publicly-accountable, collaborative approach can achieve a wide range of efficiencies such as staggering operating times, pooling patients onto a common waitlist, standardizing surgical equipment, modernizing electronic information systems and pre-screening and educating patients. These practices help prevent cancelled, delayed or inefficient surgeries that back up emergency departments, decrease patient safety and increase hospital bed utilization.

If the BC government truly wanted to cure the problem of surgical waitlists and also follow the will of the electorate, it would scale-up and expand the successes it has already achieved in reducing wait lists for surgeries across the province. But that hasn’t happened. Instead, the projects mentioned chug along in obscurity, with the provincial government seemingly content to keep it that way.

In the meantime, we hear greater rumblings about private health care, and talk of changes to the system that would foster competition instead of collaboration. In his address, Dr. Day went on to push for “activity-based” funding, a competitive payment scheme where money is given only for services performed. Of course, ‘patient-focused funding’ – the scheme’s other name – sounds more palatable. But whatever you call it, it means that hospitals end up competing with each other and with private surgery clinics for patients and funding. It leads to clinics and hospitals being proprietary about their innovations, instead of sharing the best ideas across the system.

In the United Kingdom, the National Health Service introduced similar reforms, starting in 2003. Yet things have not turned out as planned. The British Medical Association opposes this system and three years ago passed a unanimous resolution, stating “more emphasis should be placed on collaboration as opposed to competition.” Given the evidence from Britain, such a system would undermine rather than ensure the integrity of our public health care.

If patient-centered care is a priority, and if democracy means anything to this government, the actions they need to take are crystal clear.

Alicia Priest and Marcy Cohen co-authored the study “Why Wait? Public Solutions to Cure Surgical Wait Lists,” published by the Canadian Centre for Policy Alternatives.