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No Wait Times in a Government Run Healthcare System

May 28, 2009
by Pete Rivera
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There was yet another news story about how (or not) a government run Healthcare system would cause excessive wait times. I reviewed some interesting studies from the Canadian Healthcare system on average wait times by procedure or illness. In fact you now have the Canadian Prime Minister announcing that they will support new “Patient Wait Time Guarantees.” They call this “Taming of the Queue.”

For those that have run Military Medical Facilities this is nothing new. We know that healthcare is rationed by military status; Active duty, dependents of, Retired, and dependents of. If you are at the bottom of the food chain, be prepared to wait all morning to be seen. Some Family Practice Residency programs “select” their patients for each Physician panel. This means that if you did not make the list, you don’t get seen in that clinic. So who makes the list? It is often those that retired with a senior rank or had some sort of connection with someone in the system. Let's not even talk about the VA system. So why don’t we hear about this? Because it’s “free” healthcare.

So what happens in a U.S. government system? After investing more than 10.6% of our GDP we will have a comparable system as other countries. Certainty if you are a politician or a senior government worker you will not have to wait. If you can afford it, you can pay for additional coverage and get seen by a “private” physician. The average person will be taking additional time off from work to factor in the wait time to be seen. News stories will focus on horror stories of those that waited for procedures which they did not receive in time. So why do people want this type of system? Because it’s “free” healthcare.

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Pete:

My Dad passed away nearly 20 years ago in his native country - Ireland. I do know that he always complained about the "wait times" as it was based on diagnosis (for him and anyone else in that HC system). I always struggled with his level of care. I certainly do not have the answers but truly believe that any universal system that uses "wait time" models like the one my Dad lived with has major flaws in overall patient care. When he came to the US for 2-3 months each year he always loved the ability to see a healthcare provider without waiting. Our system is broken - no doubt. The system he had to deal with was no picnic either. Not at all. It had major flaws from a patient perspective.

Hi Pete, sometimes, even with the best insurance and the best docs, we wait too. See The Doctor Will See You Now

Hi Pete,
I don't hear too many people advocating a system where all the doctors and nurses are government employees, and hence, the entire system is "government-run." What people are trying to figure out is how to get health insurance for the 40 million of us who can't afford it or are excluded or bankrupted by the private insurance companies. I think it's pretty clear that "the free market" is failing us in this regard. As someone who has to buy individual health insurance policies on the open market, I can tell you I would prefer almost any system to the one we have now. And in our current private system, I have had to wait months to see a specialist or get an MRI. Is that a horror story? I think an expansion of Medicare to people not being served by private insurance makes sense. What are some other alternatives?

I wish doctors would invest in technology that would update patients using twitter (or something) if they are behind schedule or on schedule the day of their appointment. I hate going to a scheduled appointment to find out they Dr. was called to the hospital for something that morning and is behind or etc. If the Doctors office used twitter my phone would text me the morning of my appointment and say, "Dr _____ is running 30 minutes behind" or for the ER of your local hospital "For non-critical emergencies expected wait time is 2 hours currently at the ______ ER". Anytime I have taken my kids to the ER I always call in advace to let them know I'mcoming and to figure out how crowded the ER will be. It just gives me peace of mind.

I have a friend who is a doctor, living and working in London, England. According to him, the wait time, today, to get an appointment to address his high cholesterol in their national system is 18 months.

Interesting article regarding InQuickER, an online service that allows patients to hold their place in line at the ER: http://bit.ly/gqR6m.

G.

I received this comment directly to me from a Canadian physician and it made me step back and rethink the supply & demand issues associated with a government controlled healthcare system. I am posting the comment from an "anonymous source" unless I hear otherwise:

To Mr Pete Rivera,
Re. No wait times in a government run system, Healthcare Informatics blog, May 28th 2009

Hello Pete,

I am a Canadian Physician. To put it bluntly, most of what you said about the Canadian Health rationing and wait times is wrong. First, the only (official) criteria for patient triage in Canada are i) clinical urgency, and ii) first come, first served. The only rationing is via government control, by a yearly personal decision from the Health Minister of each province, of the number of new students entering med and nursing schools and the number of practice licenses. Thus, the system is kept understaffed in admin jargon, they call this "managing the offer side".

Despite government rhetoric and hype, wait times remain the main weakness of our system. We have seen some improvement but they are negligible. We still wait a median of 8.4 hrs in ERs for problems not requiring admission (see Ontario study below). In 2008, patients still wait in pain more than 10 weeks for hip replacement (see British Columbia data below). We wait weeks to see a GP, months to see a specialist. The numbers given in a 2003 Stat Can study (link below) are still largely true.

Our politicians have promised a "guarantee" but, like all guarantees, it is only as good as the fine print. The 2009 Ontario ER data shows that the wait time target set by that government is 8.0 hrs for ER patients a full day of work to get an antibiotic prescription for sinusitis! Can you imagine a U.S. HMO or private hospital boasting that their customers will wait no longer than 8 hrs in their ER? In Canada, we call this a lofty goal and our politicians proudly call this "taming the queue".

One key unanswered question is why we Canadians wait so long? When compared to, say, France or Sweden, two countries with a universal health system that costs about the same as ours, our access times is unexplicably high. After all, regardless of the length of the queue, the actual workload remains about the same patient self-removal is balanced against disease progression. Surprisingly, very few studies have tried to answer this question. The Fraser Institutes's latest study on the subject (see below) concludes: "This grim portrait is the legacy of a medical system offering low expectations cloaked in lofty rhetoric. Indeed, under the current regime (...) prospects for improvement are dim. Only substantial reform of that regime is likely to alleviate the medical system's most curable disease—waiting times that are consistently and significantly longer than physicians feel is clinically reasonable."

My personal opinion: Canadian wait times live in the minds of both doctors and patients. With the years, we have stopped seeing the obvious and have come to accept them, like snow in winter and mosquitoes in summer. If and when they become unacceptable, physicians react, work harder and clear their wait list everything else is garbage. A U.S. universal health care system will be wonderful for both countries Americans will love a cheaper option but will not tolerate months of waiting for care they can get in hours for money, and Canadians will be reminded that public health can be speedy.

References:
* Statistics Canada review of wait times, 2003: http://www.statcan.gc.ca/pub/82-575-x/2003001/4151078-eng.htm
* Ontario ER wait time data, Jan 2009 http://edrs.waittimes.net/en/provincialsummary.aspx
* British Columbia wait times data by procedure, 2009: http://www.health.gov.bc.ca/cpa/mediasite/waitlist/median.html
* Fraser Institute "Waiting your turn", 18th edition, Oct 2008: http://www.fraserinstitute.org/commerce.web/product_files/WaitingYourTur...

When I travel I am often asked why a country as rich as the U.S. does not have a national healthcare system. They view us a cold and heartless. I start digging deeper about their system and always find out that the quality and service does not compare with our systems.

The above post was from: Dr. Emmanuel Maicas, in Moncton, NB

Pete,

Very interesting post.

Any thoughts on why there's also little discussion of the "demand" side of healthcare. Healthcare is not a market-driven pure play. It seems to be often painted that way.

Part of healthcare shares some attributes of the fire department, where a free market model is not relevant to the need.

Perhaps the difference is scope. Fire departments are accountable to contain fires and to a minor degree, focus on prevention campaigns. Their role in diagnosis and treatment is relatively limited. And, the fire department has the option of simply letting a house (that has no one inside) burn to the ground. By analogy, that's accepting non-response, in effect, an infinite wait time.

Incidentally, that usually has the lowest cost, compared to applying resources to impact the fire more aggressively. In healthcare, aside from the wait time and catastrophic impacts of some delays, both government and market-based approaches to healthcare have a real hazard of directly rewarding non-care. The good news, to your point, it can be "free" to both the consumer of healthcare and without significant cost to the deliverer of non-care.

Framing in terms of waiting times is indeed generous.

Pete Rivera

Director Informatics, Hayes Management Consulting

Pete Rivera

@Gator_Pete

www.Hayesmanagement.com

 

 

 

 

 

 

 

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