healthcare wait times – US vs. Canada
In my Introduction to Sociology class I was discussing the various approaches to health care: private pay/insurance companies vs. single-payer or universal pay (government sponsored). During that discussion one of my students raised an issue that is often raised in this debate. She had heard that because health care is free in Canada, wait times are much, much longer in Canada than they are in the U.S. I responded by saying that they are actually shorter for emergency room visits in Canada, but longer for elective surgeries. She followed up via email and wanted some references and more information (it’s always great when students get so engaged in the class that they want more information). So, I did a little digging and here’s what I came up with:
The average wait time in the US to see a doctor in the emergency room has risen to about an hour in 2008, per this article. That is an increase from 2004, when it hit around 38 minutes (Wilper 2008). However, the total amount of time someone spends in the ER (both waiting and then after you see a doctor) is now up to 4 hours in the US (see this article).
Now, for the numbers on Canadian care… Of the patients who are most acute when they arrive in an emergency room in Canada, 50% are seen within 6 minutes and 86% are seen within 30 minutes. Only 1 in 10 waited three hours or more, per this report.
Comparing the numbers for the US to the numbers for Canada aren’t really accurate. The data in the US is for all emergency room visitors (both acute and not acute) while the data for Canada is primarily for the most acute. I’m guessing that the average wait time to see a doctor is actually probably pretty similar, though maybe slightly shorter in Canada. Also, overall visit time in the emergency department in at least one region in Canada is about half of that in the US (per this report; see page 7). So, average wait time to see a doctor in the ER is probably a bit shorter in Canada, but not by much. Additionally, Germany, which also has a single payer healthcare system, has shorter wait times then either Canada or the US (per this article, which is in German but with an English abstract).
For non-emergency surgeries, both elective and non-elective, Canadians do wait longer (see this article, Barton et. al. 2000, and Ho 2000). Basically, wait times for non-elective surgeries in Canada are slightly longer than in the US, but not by a huge amount. And those slightly longer wait times do not translate into worse outcomes (Ho 2000).
The question my student followed up with was: How could differences in payment systems affect wait times?
This is actually a great question. Here’s the answer per Wilper (2008): They don’t directly, but they do indirectly. When you have as many people in the US as we do who do not have health insurance (about 17% of our population), those people end up “clogging” the emergency rooms. They don’t get elective care, like people in Canada do. Instead, when they get sick, they go to emergency rooms. And since almost 1/5 of our population is doing that, that substantially increases the wait times in emergency rooms. So, indirectly, the lack of insurance coverage in the US translates into higher emergency room wait times.
The Canadian government has been criticized for the lengthy wait times, which is why they have examined this issue. For a detailed report, see here.
Since I don’t write about health care normally, I figured I’d just go ahead and post this up here. I couldn’t find an article that compared wait times directly. If anyone has one, I’d love a copy.
References:
Barton H. Hamilton, Dana P. Goldman, and Vivian Ho. “Queuing for Surgery: Is the U.S. or Canada Worse Off?” The Review of Economics and Statistics 82.2 (2000): 297-308.
Ho, V., B. H. Hamilton, and L. L. Roos. 2000. “Multiple approaches to assessing the effects of delays for hip fracture patients in the United States and Canada..” Health Services Research 34:1499–1518.
Wilper, Andrew P. et al. 2008. “Waits To See An Emergency Department Physician: U.S. Trends And Predictors, 1997-2004.” Health Aff 27:w84-95.
The average time to be seen by a physician at my hospital in rural South Carolina is under 20 minutes and the average stay is under 2 hours. We see and treat all patients that come to our facility without regard to insurance or financial status. Much of the current debate is ill-informed at best or intentionally inaccurate for preset motives at worst.
The following link describes huge wait times at some ERs in Canada- some so bad primary care physicians refuse to send emergent patients to the ER because they know the waits would harm their patients.
http://www.cbc.ca/health/story/2008/05/21/ot-er-waits-080521.html?ref=rss
Alan, I appreciate the comment. Do keep in mind, however, that comparing “best case scenario” (your hospital) with “worst case scenario” (the one in the link you sent) isn’t a fair comparison. That’s like having an Olympic sprinter challenge a 1 year-old who just learned to walk to a race and saying it is fair. You have to compare averages across the board. And as averages go, healthcare in Canada is on par with healthcare in the US as regards wait times. I’m glad your hospital is doing a great job, though; keep it up!
Please don’t let some preconceived bias cloud actual facts too much- many “commentators” on health care pick and choose studies and data sets to illustrate their misrepresentations. The difference in my biased examples- they don’t misrepresent some flaws with the Canadian system- they just point some out.
My hospital does quite well, but is hardly a “best case scenario”. There are hospitals in heavily competitive markets that achieve and advertise <5 minute door to doctor averages- by having a physician doing triage at the door prior to registration. These numbers can be manipulated to any end imaginable. The question remains- does any of it change outcomes? Or is it just another example of how superficial "appearance" equals fact in our society.
The "worst case scenario" in Quebec is by no means an isolated scenario. Please read the article. The following link is for an article "80% of western Quebec residents lack faith in ERs".
http://www.cbc.ca/canada/ottawa/story/2008/02/19/gatineau-hospitals.html
This may seem unbelievable to some that have been fed the "Canadian health care system is superior to all" dogma, but there are some major flaws in all health systems. Canadians do get more universal preventive/ primary care access. But comparing critical care, emergent care, sub-specialty, surgical care does give the US some distinct advantages.
The original article cited its own flaw "Comparing the numbers for the US to the numbers for Canada aren’t really accurate. The data in the US is for all emergency room visitors (both acute and not acute) while the data for Canada is primarily for the most acute." Then goes on to make hypothetical "I'm guessing" and "probably" statements to illustrate what point exactly?
Also, the author engages in exactly what you inaccurately critiqued my response for "comparing “best case scenario” (your hospital) with “worst case scenario” (the one in the link you sent) isn’t a fair comparison". My response describes the state of ER's in the Quebec region- with astoundingly poor wait times. The original quoted article claims "overall visit time in the emergency department in at least one region in Canada is about half of that in the US". Obviously they are not referring to Quebec.
The comparison of health systems is interesting and multifaceted, but is full of misleading numbers, examples and opinions. Honest discussion and exploration of the subject can hopefully educate us all.
Alan, I’m not using “preconceived bias” here. The articles I cited are all peer-reviewed. That doesn’t mean they are guaranteed to be without bias, but it strongly suggests that they will be. Additionally, the reports I cited are by government bureaucrats. Whether they are biased or not, I can’t say for certain, but if they were particularly biased, I would think that would be apparent as they didn’t paint overly rosy pictures. If they had, I would agree that there could be bias here.
Quebec is, in fact, the “worst case scenario” as far as I can discern in Canada. This is like taking one state in the US that has particularly large student to teacher ratios and claiming it is typical of the US. That’s not a fair comparison. I looked at averages across the country; that’s is a much fairer comparison!
I do like that you point out that there are problems with healthcare in Canada, but the articles you cite are newspaper articles and certainly aren’t authoritative. One is a poll of people who are unsatisfied with their healthcare (i.e., lack faith in it). Great. What percentage of Americans are dissatisfied with their healthcare? 78% by this poll:
http://abcnews.go.com/sections/living/US/healthcare031020_poll.html
Nifty. Americans are just about as dissatisfied as are the Quebecois (not all Canadians), but that says nothing about actual wait times, which was the point of my original post. What I did in my original post was look at the peer-reviewed literature to compare wait times across the two countries. And what I found was that for emergency care they are about the same, on average. I never claimed that was true of all hospitals, only that they are about the same on average.
If you have issues with the original post, try reading the articles I cited and the reports I cited. Then take issue with those. There was nothing in my post that was just me opining about what was going on. I was trying to provide accurate information for a student.