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  #1  
Old 10-27-2011, 04:57 PM
Wesley Clark Wesley Clark is offline
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Why do waiting lists for elective surgery in Canada save money

I have read that a reason there are waiting lists for elective surgeries in Canada is that it is a cost saving mechanism.

I know Canada doesn't have as many physicians, 2.18 per 1000 people. vs. 3-4 or higher per 1000 in most of Europe. But the US and UK are roughly where Canada is, at about 2.5 per 1000.

Canada has about 34 million people. If every year there are 1 million elective surgeries that need to be performed, why does it matter if they are done immediately or done in 6 months? At the end of the year, there are still the same number of surgeries. It isn't like people are going to be scheduling more elective surgeries just because they can get them the next day instead of 9 months from now.

I don't grasp how performing 1 million (as an example) elective surgeries a year a day or week after they are requested by a doctor, vs performing them 6-9 months after requesting them would change the cost unless the hospitals and doctors are completely booked to the brim and overworked. But Canada has comparable numbers of physicians as the UK and US, so I don't think that could be it. They also have an acceptable number of hospital beds per capita. Not extremely high, but not terrible either.

http://www.nationmaster.com/graph/he...-hospital-beds

So why does delaying surgery save money? The surgeries are still performed at the end of the delay.
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  #2  
Old 10-27-2011, 06:39 PM
The Lurker Above The Lurker Above is offline
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IANA Physician but a close family member was on the board of a local hospital for several years so I've had plenty of discussions with people in hospital administration.

Quote:
Originally Posted by Wesley Clark View Post
I have read that a reason there are waiting lists for elective surgeries in Canada is that it is a cost saving mechanism.
Do you recall where you read that waiting lists are a deliberate cost-saving measure? So far as I know the waiting lists are simply a by-product of not having unlimited funding.

Quote:
Originally Posted by Wesley Clark View Post
I don't grasp how performing 1 million (as an example) elective surgeries a year a day or week after they are requested by a doctor, vs performing them 6-9 months after requesting them would change the cost unless the hospitals and doctors are completely booked to the brim and overworked.
Ideally yes, you do want your hospital resources fully booked, otherwise you're wasting money on idle resources.

You want your resources (operating theatres, surgeons, anesthesiologists, nursing/support staff, etc) to be able to handle the maximum expected number of emergency surgeries, with a bit to spare. But since you know you won't always have a 100% load of emergency cases you fill in the gaps with elective procedures instead of building additional capacity (unless waiting lists get too long).

When I recently had my gallbladder out my surgeon had an emergency case early in the morning so my procedure was pushed back several hours. If there had been another emergency I would likely have been sent home to come back another day. That would have been annoying, but building too much capacity costs money that is better spent elsewhere in the healthcare system.
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  #3  
Old 10-27-2011, 09:23 PM
Wesley Clark Wesley Clark is offline
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Quote:
Originally Posted by The Lurker Above View Post

Do you recall where you read that waiting lists are a deliberate cost-saving measure? So far as I know the waiting lists are simply a by-product of not having unlimited funding.
In the book the healing of america by TR Reid. I already returned it to the library though, but in the Canadian system he mentions how wait lists helped save money (vs nations like Germany or France which do not really have them).

http://www.amazon.com/Healing-Americ.../dp/1594202346


Quote:
Originally Posted by The Lurker Above View Post
Ideally yes, you do want your hospital resources fully booked, otherwise you're wasting money on idle resources.

You want your resources (operating theatres, surgeons, anesthesiologists, nursing/support staff, etc) to be able to handle the maximum expected number of emergency surgeries, with a bit to spare. But since you know you won't always have a 100% load of emergency cases you fill in the gaps with elective procedures instead of building additional capacity (unless waiting lists get too long).

When I recently had my gallbladder out my surgeon had an emergency case early in the morning so my procedure was pushed back several hours. If there had been another emergency I would likely have been sent home to come back another day. That would have been annoying, but building too much capacity costs money that is better spent elsewhere in the healthcare system.
I don't know a lot about how health care is funded, but the number of physicians and hospital beds in Canada isn't terrible.

Increased capacity would increase overhead. But increased capacity of what exactly? The per capita number of physicians is not much different than what you find in the UK or US. Canada has a good number of nurses per capita, slightly above the OECD average.

http://www.nationmaster.com/graph/hea_nur-health-nurses

So Canada doesn't have fewer nurses than nations w/o wait lists for elective surgeries. They have fewer physicians and hospital beds, but not a lot less.
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  #4  
Old 10-27-2011, 09:40 PM
doreen doreen is offline
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Quote:
Originally Posted by Wesley Clark View Post
So Canada doesn't have fewer nurses than nations w/o wait lists for elective surgeries. They have fewer physicians and hospital beds, but not a lot less.
But how many surgeons compared to countries without waiting lists? If Canada has close to the same number of physicians but a higher percentage are primary care or other non-surgeons , that would contribute to a wait. Same goes for free-standing surgical centers for outpatient surgery - if there are more of those in the US than Canada, that factor could contribute to a wait. All of the elective surgeries in my family have been done in freestanding centers, not hospitals.

I read the same book, but I didn't get the impression that the wait list itself is a deliberate cost -saving measure - as you said, simply waiting six months doesn't save money. You do save money if you don't have extra surgical suites , (or radiology equipment etc - it doesn't just apply to surgery ) sitting around unused much of the time so that I can find out I need elective surgery on Tuesday and have it scheduled for Thursday.
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  #5  
Old 10-27-2011, 10:17 PM
Paul in Qatar Paul in Qatar is offline
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Generally, in economics, a line of people waiting to buy something indicates they are getting a good price. (Exception, the ski lift.)

If your hospital has not line for toe operations, that means they have an entire toe surgery team standing by waiting for you. If you have to wait a week for toe surgery, this means the nurses doctors and whatnot are all doing something more useful than just waiting around. It means your hospital has invested just about enough in toe surgery and lacks much expensive, idle capacity.
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  #6  
Old 10-27-2011, 10:33 PM
Anne Neville Anne Neville is offline
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Quote:
Originally Posted by Wesley Clark View Post
If every year there are 1 million elective surgeries that need to be performed, why does it matter if they are done immediately or done in 6 months? At the end of the year, there are still the same number of surgeries. It isn't like people are going to be scheduling more elective surgeries just because they can get them the next day instead of 9 months from now.
It may not be true that there are going to be the same number of surgeries if there's a waiting list. If there's a chance the problem, whatever it is, will get better without surgery, some people might not opt to have the surgery.

In 2002, I had a sebaceous cyst on my back that got inflamed. I scheduled surgery to have it removed, with about a month's wait (this was in the US, not Canada). By the time my surgery date came around, the inflammation wasn't there any more, and the surgeon asked if I still wanted it removed. I said yes, because it had gotten inflamed several times in the past, and since it was right under my bra strap, I figured it was likely to happen again. But not everybody would have made the same decision.

If the surgery had been available right away, it would have saved me some pain to get the cyst removed, so I would have wanted to do it, regardless of whether or not it was likely to get inflamed again. But when I waited a month, the immediate pain was gone. If people are getting surgeries for conditions like that (and I imagine people in Canada get inflamed sebaceous cysts, too), then having a waiting list might well reduce the number of surgeries being done. Obviously, if you reduce the number of surgeries being done, you reduce costs.
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  #7  
Old 10-28-2011, 08:04 AM
Hari Seldon Hari Seldon is offline
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The plain fact is that, even if the number of doctors per capita is the same as in the US, there are many more people getting medical care since everybody can afford it. In Montreal, at least, there is a dire shortage of GPs. In fact, it is basically impossible to find one and when mine retires (he is only 60, but not in good health and hasn't taken a new patient in nearly 20 years, gradually reducing his practice), I will be up s-creek. The province limits severely the number of new doctors it licences (even after paying their way through med school). It is all to save money.

I have had to wait about 6 months to schedule a colonoscopy and about the same for cataract surgeries. Neither is crucial. When I needed a pacemaker, it was scheduled in a few days. This seems like reasonable triage to me.
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  #8  
Old 10-28-2011, 11:25 PM
iamthewalrus(:3= iamthewalrus(:3= is offline
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Quote:
Originally Posted by Anne Neville View Post
It may not be true that there are going to be the same number of surgeries if there's a waiting list. If there's a chance the problem, whatever it is, will get better without surgery, some people might not opt to have the surgery.
Yep. Some people also may decide not to have the surgery, and some people will die on the waiting list.
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  #9  
Old 10-29-2011, 10:16 AM
md2000 md2000 is offline
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For larger procedures - there is a budget, and X will be done that year. I recall an item on the news where a doctor said there was a budget set aside for hip and knee replacements, so that is how many they did. "We will pay X$ a year, to cover X docotors and nurses, time, and materials." The province denies it, but others backed up his claim. The convenient thing about hip replacements, is that if the line is long enough, many of the candidates will be dead when it's time; so the line length is self-regulating. OTOH, if it's an emergency, like the person fell and broke it, the operation can happen immediately - no doubt pushing back others in line.

Since the line length is a political issue, there are tricks. My wife could not get approval for a gall bladder removal (despite recurrent attacks) until she had an ultrasound - scheduled for 4 months away. Scream and yell, and they did it in 2 weeks. Then they would not put her on a list for the surgery, would not start a list. because our small town hospital did not have an anesthetist and were looking for a new one... call back in Spetember when we expect one. She got referred to the big city by her doctor and had the operation 3 months before that.

My boss needed a new hip and knee. After 8 months wait, they started the preliminary tests for the replacement. Xrays showed metal screws in his thigh from a severe break 30 years before. (Which is why he needed the hip replacement, if they'd bothered to read his charts). Sorry, we'll put you on the list to have those out. When that operation is done, to the back of the line again for hip replacement. It took over 2 years all-in-all for him to get it. Then a year of physiotherapy... Then, they start the evaluation to see if knee replacement is necessary.

As long as the administrators (not the doctors) can find an excuse to keep you off thelist, their stats look good.

Whereas my wife's 80yo grandfather slipped and fell and broke his hip and thigh badly, and they did the replacement the same night.

Last edited by md2000; 10-29-2011 at 10:17 AM..
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