Emergency Room Madness

Commentary, Healthcare, Lee Harding

Literal delirium is a potential consequence of waiting too long in an emergency room. Unfortunately, the chances of that happening in Canada have never been greater. The Canadian Institute for Health released a report in January that showed the average wait time in an emergency room in 2016-17 was up by 11 percent. An unacceptable 1 out of every 10 people had to wait more than 32.6 hours before being admitted. Resulting in overcrowded emergency rooms, greater sickness, and even death. How did the situation get so bad and what can be done about it?

Vanessa Milne, Joshua Tepper, and Jeremy Petch asked the same questions in Emergency room overcrowding: causes and cures. In 1990, there were 4 acute care beds for every 1000 Canadians, compared to now, there are only 2.1. Budget cuts in the 1990s played a role in this result. Keeping a bed open requires paying people to staff them, so one way to deal with this is to reduce beds. The Globe and Mail found 10 hospitals run at roughly full capacity. More than half have an average occupancy of more than 85 percent.

Not surprisingly, about 13 percent of patients in acute care beds don’t belong there. But there’s nowhere else for them to go while they wait for openings in long-term care, respite beds, rehabilitation beds, or other supports before they return home. Unfortunately, increasing the number of available beds is not the answer. The Canadian Association of Emergency Practitioners (CAEP) argues this number should be reduced to no more than 5 percent. CAEP suggests an important way to get there is through financial incentives, such as pay-for-performance initiatives can encourage innovation and hospital efficiency.

Financial incentives can indeed provide solutions, but they can only be fully unleashed when Canada abandons its single-payer public system. Those who defend the status quo insist that Canada should not be like the United States in its approach to health care. Canada places the cost of drugs, dentistry, and optometry fully on the private sector, making it more like the U.S. than any other system. By contrast, Canada also bans private dollars from paying for doctors and hospital care, for which its only peers are North Korea and Cuba.

Observers like David Henderson note when health care can only be paid for by governments, those same governments ration it because it is the only tool at their disposal to minimize costs. Fewer doctors is an intentional outcome. As for patients, the triage system puts those in the worst condition at the front of the line, leaving everyone else to wait. Some of these people end up in the emergency room, where their condition may further deteriorate while waiting. Many health conditions that could have been solved inexpensively in their early stages now involve drastic and expensive measures. Meanwhile people lose productivity and leisure to wait and suffer in pain.

Market forces can alleviate Canada’s health care crisis, including its overcrowded emergency rooms. Henderson suggests that doctors and hospitals could be freed to set their own prices, that all provinces allow people to purchase private health insurance for “medically necessary” health care, and that doctors and hospitals paid by government could also provide medical care to paying customers.

Janice MacKinnon, former Saskatchewan finance minister, says some degree of patient co-payment is essential. She asks, “how can we expect patients to opt for more cost-effective medical choices, such as visiting a primary care physician or walk-in clinic rather than an emergency department, when they have no understanding of the comparative costs?”

Patients will never opt for less expensive health care choices so long as their out-of-pocket cost is zero. And as long as that remains the case, the system has one guarantee: to keep them waiting.