HEALTH CARE – How do we end emergency room madness?

The simple solution to overcrowding in our hospitals is to allow Canadians to purchase health insurance that covers medically necessary care

Research Associate
Frontier Centre for Public Policy

DELIRIUM 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.

Lee Harding.

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.

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.

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.

© Troy Media


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3 Comments on HEALTH CARE – How do we end emergency room madness?

  1. Jennie Stadnichuk // March 27, 2018 at 11:02 PM // Reply

    Has anyone studied the reason for being in the ER? As noted above by “Grouchy 1” perhaps we need to learn what defines an emergency? And, how many of these folks have not gotten to see a doctor when their doors were open (i.e. Walk in Clinics do have FINITE hours). And, how many do NOT have a doctor? So get organized and attend a Walk in Clinic when they’re open. And of course more doctors need to be trained in BC as well as encouraged to “immigrate” from other provinces with incentives (yes $$$)! Finally, how many people in RIH employment are in administrative positions? I am sure if this person truly studied this he’d be in for a shock. Yes, I know, being in various administrative jobs during my working life that Administration tends to self-propagate! What’s the best ratio for Health Care workers to administrative staff? More of the Health Care budget needs to be spent on doing the care and less on clerical etc.

  2. That’s crazy, so people who can afford extra insurance move to the front of the line and those who cannot afford it will have to be pushed to the back even if they need the care, they will see those paying separately first and to hell with anyone else.

    Here in Kamloops the ER situation is not bad at all, the longest I have been in the ER from walking in the door until they send me on my way is just over an hour. In Edmonton it was common to wait 6 – 8 hours to even be looked at and once they looked at me they threw an IV in my arm so fast and rushed me up to a room for a 1 week stay. I had been writing them notes that I seriously needed to be seen immediately. They ignored me and just snapped that others were a priority even though they would basically walk in and out in no time while I sat trying not to cry from the pain. I had knee surgery 2 days before where they had damaged my throat and I could barely swallow even my own saliva but they thought I was just complaining???

    Being there is no way to know how the human factor would play out it is a terrible idea to have financial consideration patients move to the front of the line.

  3. What a load of crap. The cure for over crowded ERs is not allowing people to use them like walk in clinics. People have to learn that the flu, or a cold is not an excuse to tie up hospital resources when there are people who are suffering from serious illnesses waiting in line. Triage as they do it now definitely does Not work as it’s supposed to by any stretch of the imagination. Triage is totally up to interpretation by the nurse on duty. If He / she is having a bad day, or is just a nasty person, patients wait ( suffer ) needlessly. Offering a way to pay for service is just wrong, and people will still be at the mercy of the system because private insurance has far more limitations on what qualifies for care than the current system.

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