© Provided by Leader Post A surgeon demonstrates a surgery in an operating room at the Regina general Hospital in 2017.
TROY FLEECE / Regina Leader-Post
Surgical wait times are long and getting longer. The pandemic has made a bad situation worse and better is a long way off. Our system isn’t swift, but what’s scandalous is that it is also grossly unfair.
If it were fair, people with similar needs would wait about the same length of time. They didn’t and they don’t. The differences are huge and the inequities are immoral.
Clearing the enormous backlog — 36,000 cases and rising in Saskatchewan, nearly 600,000 nationally — will take years even if the pandemic permanently loosens its grip on hospital capacity. As of Dec. 31, nearly 8,500 Saskatchewan patients had already waited at least a year.
And that year doesn’t include the weeks and months waiting to see the surgeon. The wait to see a specialist is longer in Canada than in any other rich country.
But only some people wait interminably. Hark back to December 2019, pre-pandemic. In Saskatchewan, 50 per cent of non-emergency patients waited no more than 39 days for their procedures. Yet 10 per cent waited 218 days or more.
Accessibility is one of the five core principles of The Canada Health Act. As with justice, access delayed is access denied.
The inequity is no accident. It’s built into how the system operates. It requires the active complicity of the Saskatchewan Health Authority and doctors to consign thousands of patients to wait time purgatory while most sail through in faster lanes.
Administrators and doctors can’t magically make the backlog disappear or reduce everyone’s wait time to a week. But if they truly cared about fairness, they would ensure that no patients wait five or 10 times longer than others with similar needs.
To be clear: Even a mediocre system can and should be fair. A shortage of capacity or operational inefficiency will increase overall wait times. But there is no reason why the added wait time burden isn’t distributed evenly.
A fair system wouldn’t schedule me for surgery 25 days into my wait for, say, a hip replacement if my neighbour has already been waiting 75 days for hers. She would be moved to the front of the line well before her wait time blew past the norm. Exceptions would have to be justified.
Perfection is impossible; if a surgeon suddenly leaves a small city or a pandemic commandeers all the hospital beds in one region, wait times will spike more for some than others.
But in normal times, the variation in wait times should be small if the system routinely monitors the wait times of all surgical patients and responds nimbly to ensure that no one gets lost in the shuffle. That’s what banks and grocery stores do when the service lines back up or become uneven. It’s called management.
So why doesn’t the system work this way? It’s because it’s a game of inside baseball, where family physicians steer patients to the surgeons they know, surgeons who pile up big wait lists bargain for more operating room time, and OR time means cash in the pocket.
The patients are conscripts in a lottery where some wait 25 days while others wait 250 days. No one, it appears, has to answer for how it plays out.
The injustice is in plain view on the Saskatchewan government website, and the Saskatchewan Health Authority board and executive team no doubt have even more detailed data. Yet nothing happens.
Grotesquely, the very long waits are often weaponized as proof that the system lacks capacity and government regularly ponies up. A large pool of long-suffering patients is good for business.
Maybe a dose of hardball would fix inside baseball. Suppose the median wait for a procedure is 60 days. For every patient who waits more than 90 days, cut the SHA funding for that case by 25 per cent and by a further one per cent for each additional day of waiting.
Do the same for the surgeon’s fee. Exclude cases where patients choose to postpone their surgery or when it would be medically unsafe to proceed.
Airline pilots share the fate of the passengers. If health system insiders had to pay a price for patients’ avoidable suffering, I’d bet these damning inequities would get their attention pretty quickly. Where appeals to conscience and duty fail, a whack to the wallet might do the trick.
Steven Lewis spent 45 years as a health policy analyst and health researcher in Saskatchewan and is currently adjunct professor of health policy at Simon Fraser University. He can be reached at slewistoon1@gmail.com.
Surgical wait times are long and getting longer. The pandemic has made a bad situation worse and better is a long way off. Our system isn’t swift, but what’s scandalous is that it is also grossly unfair.
If it were fair, people with similar needs would wait about the same length of time. They didn’t and they don’t. The differences are huge and the inequities are immoral.
Clearing the enormous backlog — 36,000 cases and rising in Saskatchewan, nearly 600,000 nationally — will take years even if the pandemic permanently loosens its grip on hospital capacity. As of Dec. 31, nearly 8,500 Saskatchewan patients had already waited at least a year.
And that year doesn’t include the weeks and months waiting to see the surgeon. The wait to see a specialist is longer in Canada than in any other rich country.
But only some people wait interminably. Hark back to December 2019, pre-pandemic. In Saskatchewan, 50 per cent of non-emergency patients waited no more than 39 days for their procedures. Yet 10 per cent waited 218 days or more.
Accessibility is one of the five core principles of The Canada Health Act. As with justice, access delayed is access denied.
The inequity is no accident. It’s built into how the system operates. It requires the active complicity of the Saskatchewan Health Authority and doctors to consign thousands of patients to wait time purgatory while most sail through in faster lanes.
Administrators and doctors can’t magically make the backlog disappear or reduce everyone’s wait time to a week. But if they truly cared about fairness, they would ensure that no patients wait five or 10 times longer than others with similar needs.
To be clear: Even a mediocre system can and should be fair. A shortage of capacity or operational inefficiency will increase overall wait times. But there is no reason why the added wait time burden isn’t distributed evenly.
A fair system wouldn’t schedule me for surgery 25 days into my wait for, say, a hip replacement if my neighbour has already been waiting 75 days for hers. She would be moved to the front of the line well before her wait time blew past the norm. Exceptions would have to be justified.
Perfection is impossible; if a surgeon suddenly leaves a small city or a pandemic commandeers all the hospital beds in one region, wait times will spike more for some than others.
But in normal times, the variation in wait times should be small if the system routinely monitors the wait times of all surgical patients and responds nimbly to ensure that no one gets lost in the shuffle. That’s what banks and grocery stores do when the service lines back up or become uneven. It’s called management.
So why doesn’t the system work this way? It’s because it’s a game of inside baseball, where family physicians steer patients to the surgeons they know, surgeons who pile up big wait lists bargain for more operating room time, and OR time means cash in the pocket.
The patients are conscripts in a lottery where some wait 25 days while others wait 250 days. No one, it appears, has to answer for how it plays out.
The injustice is in plain view on the Saskatchewan government website, and the Saskatchewan Health Authority board and executive team no doubt have even more detailed data. Yet nothing happens.
Grotesquely, the very long waits are often weaponized as proof that the system lacks capacity and government regularly ponies up. A large pool of long-suffering patients is good for business.
Maybe a dose of hardball would fix inside baseball. Suppose the median wait for a procedure is 60 days. For every patient who waits more than 90 days, cut the SHA funding for that case by 25 per cent and by a further one per cent for each additional day of waiting.
Do the same for the surgeon’s fee. Exclude cases where patients choose to postpone their surgery or when it would be medically unsafe to proceed.
Airline pilots share the fate of the passengers. If health system insiders had to pay a price for patients’ avoidable suffering, I’d bet these damning inequities would get their attention pretty quickly. Where appeals to conscience and duty fail, a whack to the wallet might do the trick.
Steven Lewis spent 45 years as a health policy analyst and health researcher in Saskatchewan and is currently adjunct professor of health policy at Simon Fraser University. He can be reached at slewistoon1@gmail.com.
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