Canada’s health system can’t seem to cast off the built-in complacency that is the mark of the second-rate. Take waiting times for prostate-cancer patients. Canada’s health ministers set a goal of four weeks wait for radiation treatment for cancer. But 70 per cent of hospitals surveyed don’t meet that goal for prostate patients. Apparently the hospitals have decided the waits won’t kill them.
Do the hospitals have sound evidence to base their decision on? No. Some prostate cancers grow slowly, but others grow fast. “What is wrong, in my opinion,” says Robert Pearcey, a former president of the Canadian Association of Canadian Oncologists, “is to assume that because many prostate cancers are slow-growing that it is safe for all prostate-cancer patients to wait.” Enter the system as a prostate patient and you could find that second-rate thinking defeats the intent of the national waiting-time standards created at the end of last year.
Those standards do not reflect some impossibly expensive ambition to be the world’s best. The radiation oncologists recommended a two-week standard; health ministers set it at four. That includes neither the time spent waiting for a consultation with a specialist nor a second wait for a scan. Fair enough. Governments wanted something reasonable and do-able. But let’s remember, they were not shooting for the moon, or the Mayo Clinic.
Speaking of second-rate, 13 of the 34 hospitals surveyed about waiting times by the radiation oncologists did not respond. That is hardly cause for confidence in those hospitals, or in the broad accuracy of the numbers. Medicare has a chronic resistance to accountability. Alberta reports radiation waiting times on its website that are more than a year old. Behind such resistance lurks complacency.
It sounds like an oxymoron, but that complacency is tenacious. Canadians have told their governments that the number-one problem in health care is the wait for crucial care. The Supreme Court of Canada has put governments across the land on notice that if the waits persist, medicare’s constitutional foundation could be brought crashing down. Canada has given $5.5-billion to a Wait Times Reduction Fund. All that energy, and yet barely half (53 per cent) of hospitals are meeting the four-week waiting standard for breast-cancer patients.
Even the national program to cut waiting times seems fatally complacent. The provinces have until Dec. 31, 2007, to develop plans to meet their waiting-time targets. And no, there is no enforcement mechanism to ensure the targets are met — other than Canadians screaming at the top of their lungs, or the Supreme Court doing the judicial equivalent. Prime Minister Stephen Harper’s election promise of a waiting-times guarantee was phony; only the provinces can make such a guarantee work, and they insist on even more federal cash before they will go ahead.
Canada is not the world’s richest country, but it is prosperous and its citizens insist on a first-rate cancer-care system. Governments, hearing that message, have kicked in ever-larger sums ($21.5-billion in 2000 over four years, $27.5-billion in 2003 over five years and $41-billion in 2004 over 10 years from Ottawa) to make it so. Money alone is not enough; the health system has to commit to excellence. As the waits show, complacency is still winning out over the commitment to be first-rate.
