October 31, 2006 1:56PM

Health Care Involves Non‐​Monetary Costs, Too

The Fraser Institute of Vancouver, B.C., has released its 16th annual “Waiting Your Turn” report on waiting times for health care in Canada’s state‐​run Medicare system. The median wait for surgical and therapeutic services increased slightly over the 2005 median to less than one day shy of their all‐​time high of 17.9 weeks in 2004. Throwing more money at the system doesn’t seem to make a difference; the Frazer Institute has documented that waiting times often increase with increased spending on Canada’s Medicare program.

This year’s report had special significance for me. Four Sundays ago, I tore my ACL playing soccer. The following Tuesday, I saw an orthopedic surgeon. On Wednesday, I had an MRI. (As a cash‐​paying patient, I had people offering to cut their MRI list price in half.) The next Tuesday, I saw the orthopedist again. He diagnosed the torn ACL and recommended surgery, which he could schedule as early as November 9th. That’s 4.6 weeks after injury, 3.3 weeks after diagnosis. 

Nadeem Esmail, the lead author of the Fraser report, helped me work out how I would have fared in Canada. Esmail estimates that, “not counting issues actually getting the referral to a specialist from a GP in the first place,” a typical Canadian could expect to wait:

  • 16.2 weeks to see an orthopedic surgeon,
  • 10.3 weeks for an MRI, and then another
  • 16.5 weeks for ACL reconstruction surgery.

All told, that’s 43 weeks; I could expect to have my ACL reconstructed in early August 2007. And with a six‐​month recovery time, I’d be good as new by February 2008.

As it turns out, I’m not having the surgery done on the earliest possible date. I’m able to walk without too much pain, so I’m taking some time to strengthen my knee, and to research procedures, surgeons, and prices. Not all waits are problematic. 

But it’s nice to have the choice. Were I forced to wait until next August for surgery, that would impose significant costs on me and on others. I would be living in pain, with limited mobility, and might further injure my much‐​weakened knee. My wife would have to endure nine additional months of complaining. Plus, think of all the games my soccer team might lose. 

America’s health care sector is full of waste, but when people say that Canada’s system is cheaper, they’re leaving out some very real non‐​monetary costs. Canada’s Supreme Court acknowledged those non‐​monetary costs in a 2005 opinion that struck down Quebec’s ban on private insurance:

Dr. Eric Lenczner, an orthopaedic surgeon, testified that the usual waiting time … for patients who require orthopaedic surgery increases the risk that their injuries will become irreparable.… [He] also stated that many patients on nonurgent waiting lists for orthopaedic surgery are in pain and cannot walk or enjoy any real quality of life.

The ban on private health insurance effectively kept people from spending more money on health care to reduce health care costs. (The story of the man who defeated that ban can be found here.) 

Only the individual patient can tally those non‐​monetary costs and weigh them against the cost of treatment. If we’re really interested in lowering health care costs, we need to give the patients the money, and let them choose the lowest‐​cost option.