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Waiting Your Turn: Hospital Waiting Lists in Canada
...The extent of Canada’s health system dysfunction was
documented in a 2000 Fraser Institute study that
examined the impact of increases in government
health spending. The study’s analysis revealed that
provinces spending more on health care per person
had neither shorter (nor longer) total waiting times
than those spending less. In addition, those provinces
spending more had no higher rates of surgical specialist
services (consultations plus procedures) and had
lower rates of procedures and major surgeries (Zelder,
2000b). A follow-up study in 2003 found that increased
spending was actually correlated with increases in waiting
times unless those increases in spending were targeted
to physicians or pharmaceuticals (Esmail, 2003).

Finally, the promise of the Canadian health care system
is not being realized. On the contrary, a profusion of
research reveals that cardiovascular surgery queues
are routinely jumped by the famous and politically connected,
that suburban and rural residents confront
barriers to access not encountered by their urban
counterparts, and that low-income Canadians have
less access to specialists, particularly cardiovascular
ones, are less likely to utilize diagnostic imaging, and
have lower cardiovascular and cancer survival rates
than their higher-income neighbours....

...A second qualification is that non-price rationing of a
vital product such as medical services is fair and is perceived
to be fair by society. To the extent that fairness
is an objective, one might argue that non-price rationing
provides collective benefits that outweigh the inefficiencies
identified above. However, depending upon
how the non-price rationing occurs, the resulting distribution
of benefits may not be any improvement
upon the price-rationing outcome. In fact, many inequities
have been discovered in the current system.
Preferential access to cardiovascular surgery on the
basis of “nonclinical factors” such as personal prominence
or political connections is common (see Alter,
Basinski, and Naylor, 1998). As well, residents of suburban
Toronto and Vancouver have been found to experience
longer waiting times than do their urban
counterparts (Ramsay, 1997) and residents of northern
Ontario receive substantially lower travel reimbursement
from the provincial government than do southern
Ontarians when travelling for radiation treatment
(Priest, 2000; and Ombudsman Ontario, 2001). Finally,
low-income Canadians are less likely to visit medical
specialists, including cardiac specialists (Dunlop,
Coyte, and McIsaac, 2000), are less likely to utilize
diagnostic imaging (Demeter et al., 2005), and have
lower cardiac and cancer survival rates (Alter, et al.
1999; Mackillop, 1997) than higher-income Canadians.
This evidence indicates that rationing by waiting is
often a facade for a system of personal privilege, and
perhaps even greater inequality than rationing by
price....