It cost Canada's economy $14.8 billion in 2007 to have patients waiting longer than needed for medical procedures, estimates a new analysis commissioned for the Canadian Medical Association.

The analysis, conducted by The Centre for Spatial Economics, focused on just four key medical procedures:

• Total joint replacement surgery,
• Cataract surgery,
• Coronary artery bypass graft surgery
• Magnetic resonance imaging (MRI) scans

It found that having patients wait for these procedures cost federal and provincial government revenues a combined $4.4 billion in 2007.

The analysis focused on the costs of "excess waits" -- that is: the cost of waiting for treatment beyond maximum recommended wait times as assessed by the Wait Time Alliance for Timely Access to Health Care.

The study found that "excess waits" rob the economy of workers -- both the patients and their caregivers. They also lead to increased costs on the health care system, as patients need extra appointments, tests and medication. And they cost governments through disability pensions and welfare costs, as well as in lost tax revenue.

"The deterioration that patients experience while they wait is a curse," says CMA President Dr. Brian Day. "Not only on the patients who must wait in pain but also for the economy of the entire country."

The CMA notes that their analysis is conservative. It addresses only the time a patient waits for a treatment or MRI after it has been ordered by a specialist. It does not include the wait in getting to see that specialist -- or even in getting to see one's family doctor.

The solution, the CMA concludes, is simple: reduce wait times.

"It's time to cut wait times by investing in health care, an investment that will pay dividends for patients, for Canada's economy and for all Canadians," the report concludes.

The report does not calculate how much it would cost for governments to invest in the health-care system to lower wait times. But Day insists this analysis demonstrates that it must be cheaper to reduce wait times than to keep the status quo.

Three kinds of costs

This study breaks down the costs of waiting into three categories:

1. Patient costs: These costs measure the impact from reduced economic activity as a result of patients being unable to participate in the labour force.
2. Caregiver costs: Theses costs measure the impact of caregivers giving up work to care for family members or relatives.
3. Health care system costs: These costs include the additional costs from patients attending medical appointments, submitting to tests, and taking medications that would not have been needed had they not had to wait longer than the maximum recommended.

The analysis recognizes that not every wait time means that patients cannot work. among patients waiting for an MRI, for example, few need to stop their regular activities while waiting. That means there are relatively low per-patient wait time costs for MRIs -- despite the fact that the median patient still waits 56 days for an MRI, and some wait longer than 85 days.

But in the cases of coronary bypass surgery, a high proportion of patients must stop their regular activities while waiting for treatment, raising the per-patient wait time cost despite the relatively short length of that wait.

Dr. Michael Dunbar, an orthopedic surgeon based in Halifax believes there are also hidden costs associated with asking patients to wait long times for surgery.

"The evidence would suggest that if they wait too long, from a medical and surgical point of view they don't do as well as if they would had the surgery been done expeditiously," he tells CTV.

Reaction

Dr. Walter P. Wodchis, of the Health Management Policy & Evaluation Department at the University of Toronto says the report makes a lot of assumptions, first among them is that patients take time off work while they wait for treatment.

"This is undoubtedly not true, as many people aren't in the labour force anymore, and many people can't afford to take time off work," he told CTV.

The CMA analysis did find some positive news: last year, the average patient waited less than the maximum recommended wait time for treatment. But among those who waited longer, many waited considerably longer.

For example, the average Canadian patient who was not treated within the wait-time limit in 2007 waited a year for a hip or knee replacement and seven months for cataract surgery. Heart patients not treated within the recommended period had to wait an average of more than three months for bypass surgery.

That costs everybody, says the CMA.

But Wodchis says he's not sure he agrees that the solution is it to eliminate wait times altogether, as the CMA would like. While that might be ideal for patients and doctors, Wodchis says, it is not realistic, since it would require considerable excess capacity, i.e. having operating rooms sitting empty.

"You can think about the line at the grocery store; it would be wasteful to have every cashier there all the time, just to be sure that no one ever had to wait," he notes.

Along with the release of the report, the CMA also launched a campaign Tuesday to address the shortage of physicians in Canada. The "More Doctors. More Care" campaign is aimed at encouraging federal politicians to take action to recruit more doctors.

"Federal politicians seem to think that health care is no longer an important issue for Canadian voters," Day said in a statement. "They need to think again.

"In the last election, politicians promised to put an end to wait times. That promise will never be kept if the shortage of physicians isn't dealt with because more doctors mean more care."

The CMA encourages Canadians to take part in the online part of the campaign by visiting the website MoreDoctors.ca