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How do we end emergency room madness?
664 words

Lee HardingDelirium can result from waiting too long in an emergency room. And the chances of that happening in Canada have never been greater.

The Canadian Institute for Health Information released a report in January that showed the average wait time in an emergency room in 2016-17 was up by 11 per cent. An unacceptable one out of every 10 people had to wait more than 32.6 hours before being admitted.

The outcome of overcrowded emergency rooms?

Greater sickness, suffering 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 four acute care beds for every 1,000 Canadians; now, there are only 2.1.

Government budget cuts in the 1990s played a role in creating this situation. Keeping beds open requires paying people to staff them, so one way to cut staff is to reduce beds. The Globe and Mail reported last year that 10 Ontario hospitals run at or above full capacity. And 89 Ontario hospitals had an average occupancy of more than 85 per cent. The Globe reports that “85 per cent [is] the threshold that many experts describe as the ideal for preventing the spread of infection and accommodating unexpected surges of patients.”

Not surprisingly, about 13 per cent 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.

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Unfortunately, increasing the number of available beds isn’t the answer.

The Canadian Association of Emergency Physicians (CAEP) argues that this number be reduced to no more than five per cent. CAEP suggests an important way to get there is through financial incentives, such as pay-for-performance initiatives that will 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.

But Canada also bans private dollars from paying for doctors and hospital care. In that regard, its only peers are North Korea and Cuba.

Observers like David Henderson note that when health care can only be paid for by governments, those same governments ration it because it’s the only tool at their disposal to minimize costs. Fewer doctors is an intentional outcome.

The triage system puts those patients in the worst condition at the front of the line, leaving everyone else to wait. The conditions of some of these people 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 as they 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 be freed to set their prices, that all provinces allow people to purchase private health insurance for “medically necessary” care, and that doctors and hospitals paid by government could also provide care to paying customers.

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Janice MacKinnon, a 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.

Lee Harding is a research associate with the Frontier Centre for Public Policy.

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