It has been apparent for years that wait lists for hip and knee surgery are unacceptably long in B.C. Across the province, just 61 per cent of patients requiring a hip replacement receive treatment within the benchmark period of 26 weeks. Just 47 per cent get knee replacements on time.
After Nova Scotia, those are the worst scores in Canada, and more troubling still, they’re not getting better, they’re getting worse. In Saskatchewan, by comparison, 100 per cent of hip surgeries meet the benchmark period, as do 99 per cent of knee operations.
We regularly get letters to the editor from readers who have endured prolonged periods of pain while waiting for treatment. Some eventually fly to the U.S. and pay from $30,000 to $40,000 for treatment they should have received here.
The question is, why are we doing so poorly?
It’s true that patients requiring emergency surgery are treated promptly. Yet large numbers of British Columbians, most of them elderly, are being put through hell.
One possible explanation is that growing demand for these procedures took governments by surprise. Between 2002 and 2014, B.C.’s population expanded 24 per cent. But over the same period, the number of hip and knee operations rose nearly 120 per cent — five times that growth rate.
Some of it has to do with aging, as well as higher levels of obesity. Yet those factors fall short of explaining what’s happened.
Improved surgical techniques have likely played a part, and better anesthetics, also. However, that is still not the whole story.
Orthopedic surgeons are paid on a fee-for-service basis. The more operations they do, the higher their salaries. A long waiting list is a guarantee of future income.
So does everyone on a wait list belong there? Bottom line: We don’t know. Regional health authorities do not conduct audits to check whether each operation is clinically appropriate. Maybe they should.
Nevertheless, with 2,850 people on Vancouver Island alone waiting for joint surgery, the problem clearly goes beyond occasional gaming of the system. By any measure, we are not meeting the need.
Inadequate funding is an obvious concern. The health ministry recently provided $25 million to purchase additional procedures.
But it appears that might have simply lengthened the wait lists. In effect, physicians who had been holding back bookings because they knew the system was clogged came forward with additional patients. (The same thing happened when more money was provided to increase the number of MRI scans. Wait lists initially remained constant.)
Yet this is not mission impossible. The average cost of a hip or knee replacement is about $10,000.
Since there are 10,700 patients, provincewide, on the wait list, conducting those operations would cost $53 million — a manageable sum.
Unfortunately, it’s not that simple. Additional nurses would have to be hired, new operating rooms built and more recovery beds installed. Add all that together, and the total cost would be much greater.
Still, other provinces have tackled this difficulty, in part, by contracting with private clinics. These provide the necessary infrastructure, while working within the public system. That means patients don’t pay. Island Health is pursuing this option.
Some jurisdictions have also shortened hospital stays for hip operations, with some patients going home the same day. That also saves money.
Here, though, is the unavoidable reality. We are well behind the rest of the country in providing an essential medical service. And the shortfall will only grow more acute as our population ages.
It’s also clear that tinkering around the edges hasn’t worked. We need some new thinking, and yes, more money, and we need it now.
