Published in the National Post on March 22, 2011
By Colin Busby
Do you have a sharp pain in your stomach that won't go away? If yes, you may soon visit an emergency room for help. Your next decision is whether to go to Toronto General, Western, St. Michael's, etc., for service. As an aid, the Ontario Ministry of Health and Long-Term Care posts online monthly updates of average ER wait times for complex (strokes, chest pains, etc.) and non-complex (sprains, cuts, etc.) patients at each hospital.
For starters, we should applaud this initiative: transparency is the first step to bringing wait times down to provincial standards. Plus, a corresponding pay-for-results initiative encourages improved hospital performance.
But the challenge of reducing ER wait times is so complex that smarter, bigger incentives are needed. The GTA is a case in point: with 16 emergency service hospitals in a 25-kilometre radius, hospitals should be encouraged to compete for patients.
Since April 2008, when Ontario's ER wait-times strategy was put in place, the average time spent waiting in emergency departments for all visits province-wide has fallen from 9.4 to 8.5 hours -a notable improvement. But important work remains. Admitted patients' wait times stubbornly remain at an average of 31.5 hours -almost a full 24 hours above provincial standards.
A more patient-focused strategy would encourage competition and cut wait times by attaching money to patients -where the patients go, so does the money. Funds could be paid to hospitals on a per-patient basis, with amounts corresponding to care needs.
With this funding, patients become customers, not users, to healthcare providers. Hospitals would compete for patient dollars. More importantly, patients would go wherever they can get the fastest, highestquality service.
For a GTA initiative, the Ontario government could track hospital ER waits in real time. Results could be available using cellphone applications or with instant text messages, so the screen would show wait times by hospital, and average driving times to each destination. Further, the application could show alternatives, such as the hours and locations of community health services and walk-in clinics.
Attracting patients means reducing wait times and improving services. Hospitals would have the incentive to improve processes within the ER and rapidly discharge patients. Plus, hospitals would be allowed to keep the surplus funds and decide where and how to use them.
Other countries with large public health systems have used incentives for successful reforms. In 1992, Sweden, then burdened by slow access to care, enacted the National Care Guarantee. The proposal enforced wait-time standards by providing individuals who were not able to receive proper care within this time frame an unlimited voucher to go anywhere in the country for services. Waiting lists fell by 22% in a year's time.
In 1991, Britain's National Health Service tried to create an internal market between health-care providers and funders. Funders, such as local health networks, managed a general budget and had the ability to choose which hospital would provide specific health-care services for their patients. Reforms encouraged providers to improve services and compete for scarce funding.
Unique in Ontario, the cluster of hospitals in the GTA provide the perfect setting to test alternatives. The new website and strategy for wait times is an important, formal recognition of the problem. Progress has taken place.
But the more our health care system is designed to respond to patient needs, the more our health-care system will be effective in meeting the needs of its citizenry.
Colin Busby is a senior policy analyst with the C.D. Howe Institute in Toronto.
