Figure 1
Patients Having to Wait More Than Four Months for Surgery (as percentage of all adult
surgery patients receiving elective [nonemergency] surgery in last two years)
36%
27%
26%
23%
5%
United States
Aus tralia
New Zealand
Canada
Britain
During one
Source: Cathy Schoen, Robert J. Blendon, Catherine M. DesRoches, and Robin Osborn, “Comparison of Health
12-month period
Care System Views and Experiences in Five Nations, 2001,” Commonwealth Fund, Issue Brief, May 2002.
in Ontario,
scan for themselves is illegal (although more
ple waiting for surgery or treatment in New
Canada, 71
and more human patients are finding legal
Zealand in 1997, more than 20,000 were
loopholes, as we shall see below).10
waiting for a period of more than two years.16
patients died
Countries with national health insurance
The London-based Adam Smith Institute
waiting for
limit health care spending by limiting supply.
estimates that the people currently on NHS
coronary bypass
They do so primarily by imposing global budg-
waiting lists will collectively wait about one
ets on hospitals and area health authorities
million years longer to receive treatment
surgery.
than doctors deem acceptable.17
and skimping on high-tech equipment. The
result is rationing by waiting (see Figure 1).
Among the patients waiting, many are wait-
In Britain, with a population of almost 60
ing in pain. Others are risking their lives. Delays
million, government statistics show that more
in Britain for colon cancer treatment are so long
than 1 million are waiting to be admitted to
that 20 percent of the cases considered curable
hospitals at any one time.11 In Canada, with a
at time of diagnosis are incurable by the time of
treatment.18 During one 12-month period in
population of more than 31 million, the inde-
pendent Fraser Institute found that more than
Ontario, Canada, 71 patients died waiting for
876,584 are waiting for treatment of all types.12
coronary bypass surgery while 121 patients
were removed from the list because they had
And in New Zealand, with a population of
become too sick to undergo surgery with a rea-
about 3.6 million, almost 111,000 people are on
waiting lists for surgery and other treatments.13
sonable chance of survival.19
Although there may be some waiting in
any health care system, in these countries
Myth No. 2: Countries with
rationing by waiting is government policy.
National Health Insurance
Patients may wait for months or even years
for treatment (see Figure 1).14 For example,
Systems Deliver High-
Canadian patients waited an average of 8.3
Quality Health Care
weeks in 2003 from the time they were
referred to a specialist until the actual con-
In countries with national health insur-
sultation, and another 9.5 weeks before treat-
ance, governments often attempt to limit
ment, including surgery.15 Of the 90,000 peo-
demand for medical services by having fewer
3