News:
It All Comes Down to Waiting Lists

August 19, 2004

 

Peter A. Singer (published in The Globe and Mail )

 

At the Canadian Medical Association's annual meeting on Monday, Ontario Premier Dalton McGuinty and federal Health Minister Ujjal Dosanjh were jostling over the correct focus for medicare reform. The premiers want their Sept. 13 meeting with the Prime Minister to focus on pharmacare. The Prime Minister wants to prioritize waiting lists. The focus should be on waiting lists.

 

The premiers' gambit to get Ottawa to take over and expand pharmacare coverage was indeed "a stroke of brilliance," as Alberta's Ralph Klein said. Their proposal would transfer a time bomb of escalating costs and political headache to the federal government, without ceding any accountability while freeing up billions.

 

Drugs are among the fastest growing expenditures, at 8.1 per cent per year. The premiers' proposal would transfer this cost-escalation problem to the federal government. About $16-billion is spent annually on prescription drugs, of which 47.2 per cent is financed by the public sector. Total spending on drugs is $19.6-billion, or about $620 for each Canadian. This represents 16.2 per cent of the $121.4-billion spent on health care in Canada, second only to hospitals (at 30 per cent of spending) and ahead of physicians (at 12.9 per cent).

 

The proposal would also transfer a political headache to the feds. When Ontario eyed clawing back drug coverage for seniors as a way to balance the books before its budget earlier this year, it faced a storm from seniors groups. Ultimately, Ontario introduced the health premium instead.

 

The shrewdest reason for transferring pharmacare is avoiding accountability of the provinces for increased federal dollars. The provinces want Ottawa to "just send money." But what 25-per-cent shareholder in a $120-billion enterprise would not want to be on the board? Federal involvement on waiting lists would mean that new federal dollars would come at the price of provincial accountability; federal involvement on pharmacare does not.

 

As McGuinty emphasized, if Ottawa funded pharmacare, the provinces would have billions of dollars freed up, and they would tackle waiting lists. But Ottawa would not be a player, and there would be attenuated national focus on this problem.

 

What is the main problem in Canadian health care? That full public drug coverage is not available? That home care is not fully publicly funded? That primary care is not organized into teams? No -- Canadians' chief complaint is that waiting lists are too long.

 

The slogan behind Prime Minister Paul Martin during the election campaign didn't proclaim "full drug funding", but rather "shorter waiting times." The Liberal platform contained the "five in five" plan to shorten waiting lists in five key areas - cancer, heart, diagnostic imaging, joint replacements, and sight restoration -- within five years.

 

The pieces are falling into place. The political will of Canadians was mobilized in the last election. The Canadian Institute for Health Information has begun to compile information on which provinces collect data on which waiting lists. The Canadian Institute of Health Research and the Canadian Health Services Research Foundation have financed projects on waiting lists. The Western Canada Waiting List Project, with support from Health Canada and the Western provinces, is developing tools to manage waiting lists. The Health Council of Canada (unfortunately, without Alberta and Quebec) has been set up to report to Canadians on the state of their health system; one of its priorities is waiting lists.

 

But one key element is missing -- a federal fund that would reward provinces for shortening waiting lists. Provinces might try to do this through improved pharmacare, home care or other measures, but with a focus on bottlenecks that keep patients waiting. This sort of decentralized experiementation is needed to attain the national goal.

 

Waiting lists have complex causes and are tough to fix. Mr. Martin has not made things easy on himself by promising to shorten them. But his goal focuses on the most important health-care issue for Canadians. The Prime Minister has held himself accountable for shortening waiting times. The least we can do is let him.

 

Peter A. Singer is director of the University of Toronto's Joint Centre for Bioethics.

 

© August 19, 2004 The Globe and Mail