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THE ISSUE

Twelve long years of Liberal government have done nothing to shorten health care waiting lists for Canadians. Canadians are waiting longer to see a doctor or a specialist. They are waiting longer for access to critical surgery and specialist services. Since the Liberals took power, the time that patients wait to be seen by a specialist has almost doubled ― from 9.3 weeks to 17.7 weeks.1 More and more Canadians are avoiding waiting lists by crossing the border or seeking private clinics in Canada to get the service they need.

This crisis recently came to the attention of the Supreme Court of Canada, which concluded that many Canadian patients are suffering, and some even dying, while they wait for necessary medical treatment. In the words of the Chief Justice Beverley McLachlin and Justice John Major:2

“The evidence in this case shows that delays in the public health care system are widespread, and that in some serious cases, patients die as a result of waiting lists for public health care. … denying people vital health care result[s] in physical and psychological suffering that meets a threshold test of seriousness.”

The Liberals have also failed to meet commitments they have made in their health accords:

• Evidence-based benchmarks for medically acceptable wait times have not been established;
• Wait time reduction targets are behind schedule; and
• Rather than comprehensive benchmarks for wait times, the government is now promising only selective measures from each province by the end of 2005.

The issue is one of human rights. In the Chaoulli case, the Supreme Court held that forcing patients to wait for treatment violates the Quebec Charter of Human Rights and Freedoms and (according to three of the four majority judges) contravenes the Canadian Charter of Rights and Freedoms.

Referring to Charter’s guarantees of life and security of the person, the Chief Justice and Justice Major wrote:

“Where lack of timely health care can result in death, the s. 7 protection of life is engaged; where it can result in serious psychological and physical suffering, the s. 7 protection of security of the person is triggered …”

In clear and unambiguous terms, the judges declared what thousands of Canadian patients know all too well:

“Access to a waiting list is not access to health care.”

Conservatives agree. Canadian patients should not face unnecessary waits for medically necessary services. Canadians deserve a government that fulfills its health care promises and delivers timely access to quality health care services regardless of ability to pay.

In the October 2004 Health Accord, the federal and provincial governments agreed to establish maximum acceptable waiting times for cancer care, heart surgery, diagnostic imaging, joint replacement surgery, and sight restoration by December 2005.

Unfortunately, governments will then have until December 2007 — two years from now — to set targets and actually begin to meet those maximum wait times.

Even worse, it appears that instead of identifying acceptable wait times by the end of this month, governments will only provide “representative” benchmarks for various procedures.

This is not good enough. The Wait Times Alliance, representing the Canadian Medical Association and six national specialist organizations, has already reported on clinically acceptable maximum wait times. The Alliance has recommended that governments set their targets for meeting those wait times by spring of 2006.

In its April 2005 report, the Wait Times Alliance set the following medically acceptable limits:

• in routine cases, cancer patients should receive radiation therapy within ten working days of consultation with an oncologist;
  
• non-urgent hip and knee replacement surgery should be performed within ten months after the patient first sees an orthopedic surgeon;
  
• emergency patients should receive needed CT and MRIs within 24 hours;
  
• cataract surgery should be provided for routine treatment within four months; and
  
• coronary artery bypass graft surgery should be provided within 48 hours of an emergency and within 42 to180 days in routine cases.

Conservatives agree with the Wait Times Alliance that governments should set and start meeting the targets now, not two years from now. We will bring all governments back to the table, not to bicker about more money, but to set wait time targets across the country, and figure out a plan to begin meeting them. That process will begin immediately after the election, and conclude in 2006.

Another patient concern is the lack of access to family doctors. 1.2 million Canadians still lack access to a family physician.3 This represents a shortage of at least 3,000 family doctors.

THE PLAN

The Conservatives have endorsed the September 2004 federal-provincial Health Accord. We will hold all governments accountable to the commitments made in that accord.

A Conservative government will work with the provinces to develop a Patient Wait Times Guarantee to ensure that all Canadians receive essential medical treatment within clinically acceptable waiting times.

Clearly and unequivocally embracing the Patient Wait Times Guarantee is the only way governments can preserve both the principles of the Canada Health Act and the Charter of Rights and Freedoms.

A Conservative government will ensure that:

• Evidence-based benchmarks for medically acceptable wait times, starting with cancer, heart, diagnostic imaging procedures, joint replacements, and sight restoration are established as soon as possible, as promised in the Health Accord;
• Wait-reduction targets for priority procedures identified by provinces are established by the end of 2006; and
  
• Canadians get regular reports on progress towards meeting these wait-time targets, as promised in the Health Accord.

We will also work to increase the supply of health care professionals in Canada by cooperating with the provinces and territories to expand educational programs for doctors, nurses, and other health professionals.

The Patient Wait Times Guarantee will ensure that all Canadians receive timely access to necessary medical procedures. The concept of the guarantee is that patients must be able to receive treatment in a medically acceptable maximum time for a publicly insured service. If this is not available in their own area, they must be given the option of receiving treatment at another hospital or clinic, even outside of their home province.

The Patient Wait Times Guarantee will be based on the recommendation of the bi-partisan Senate committee chaired by Michael Kirby and Marjory LeBreton with the key contribution of Dr. Wilbert Keon. In its final report, The Health of Canadians – The Federal Role, Volume Six: Recommendations for Reform (October 2002), section 6.5, the “Kirby Committee” recommended as follows:

“In keeping with its philosophy that the best way to reform a complex system such as health care delivery is to introduce appropriate incentives for all the players involved, the Committee is firmly convinced that governments must be made to bear the responsibility for their decisions. Thus, the Committee believes that the blame for the waiting list problem should be placed where it belongs – on the shoulders of governments for not funding the system adequately, and jointly on governments and providers of health services, the providers for not developing clinical, needs-based waiting list management systems and governments for not demanding and funding such systems to ensure the rationality of waiting lists, including those that are attributable to underfunding. The Committee believes that governments must pay for the remedy, namely patient treatment in another jurisdiction, while waiting list management systems are being developed and put in place.

“Therefore, the Committee recommends that:

“For each type of major procedure or treatment, a maximum needs-based waiting time be established and made public.

“When this maximum time is reached, the insurer (government) pay for the patient to seek the procedure or treatment immediately in another jurisdiction, including, if necessary, another country (e.g., the United States). This is called the Health Care Guarantee.

“The Committee realizes that governments may well take the position that if a patient does not receive timely access for a medically necessary service, and hence becomes entitled to service elsewhere under the health care guarantee, the responsibility (or blame) may rest with the hospital or its physicians for not being sufficiently efficient in the use of existing resources and not managing waiting lists well enough. Under these circumstances, the government may well seek to recover the costs incurred through the care guarantee from the hospital and/or the physician(s) concerned. That is, governments may well place the responsibility for meeting the maximum waiting times on the shoulders of those responsible for actually managing the system. This is reasonable if it can be shown that underfunding is not the sole or even the primary cause of a patient waiting too long for a service.

“But this is an issue to be resolved between governments and the institutions and the physicians that they fund. Patients should not be affected. Their sole concern should be to get needed treatments in a timely fashion and to have them paid for publicly. Therefore, in the first instance, governments as the patient’s insurer should have the responsibility of meeting the health care guarantee.”

THE CHOICE

The Liberals have done nothing to reduce wait times other than throw money at the problem and engage in excessive partisan rhetoric. They have failed to reduce wait times. They have failed to honour the commitments they made in the 2004 Health Accord. And they continue to engage in false rhetoric about private health care while at the same time the Quebec wing of the Liberal Party of Canada passes a resolution to allow private insurance to pay for health care. The Liberal record on health care is littered with hypocrisy and inaction. Only a new Conservative government will give Canadians a Wait Times Health Care Guarantee. Only the Conservatives will deliver timely access to quality health care services regardless of ability to pay.

1. Average waiting time from referral by a general practitioner until treatment by a specialist. 1993 and 2004 figures from the Fraser Institute.
2. Chaoulli v. Quebec (Attorney General), 2005 SCC 35. Justice Michel Bastarache concurred in the decision of Chief Justice McLachlin and Justice Major.
3. Statistics Canada, “Canadian Community Health Survey,” The Daily (June 15, 2004): online: http://www.statcan.ca/Daily/English/040615/d040615b.htm