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.