Medical wait lists
==================

* Michael Tremblay

Clearly, from Mark Baerlocher and Allan Detsky's Pulse article on waiting times in richer provinces,1 money and availability of specialists are not the determinants of waiting lists. But we knew this. Canada is one of the highest-spending countries within the Organisation for Economic Co-operation and Development, as measured by per capita spending on gross domestic product, but it is also the highest-spending country with waiting lists.2–4 Furthermore, it is probably the one country that has consistently failed to gain traction on health system reform over the past 15 years or so. The problem of waiting lists isn't about how much you have; rather, it is about what you do with what you have: whether the money is spent on high-cost hospitals or lower-cost and accessible primary care, for instance, or whether the regulation of health professions encourages a union shop approach to work flow, which can frustrate the reform of health care work itself.

Without appropriate answers to these questions, the problem of waiting for health care will continue to inconvenience and complicate the lives of Canadian citizens and bedevil policy-makers and health system decision-makers. 

## REFERENCES

1.  1. Baerlocher MO, Detsky AS. Do richer provinces have shorter waiting times to see specialists? CMAJ 2006;174(4):447.
    
    [FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czo5OiIxNzQvNC80NDciO3M6NDoiYXRvbSI7czoyNDoiL2NtYWovMTc0LzExLzE1OTkuMS5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

2.  2. Esmail N, Walker M. How good is Canadian healthcare? 2005 report. An international comparison of health care systems. Vancouver: Fraser Institute; 2005. Available: [www.fraserinstitute.ca/admin/books/files/HowGoodIsCanHealthCare2005.pdf](http://www.fraserinstitute.ca/admin/books/files/HowGoodIsCanHealthCare2005.pdf) (accessed 2006 Apr 24).
    
    

3.  3. Anderson G, Hussey P, Frogner B, et al. Health spending in the United States and the rest of the industrialized world. Health Aff 2005;24:903-14.
    
    [Abstract/FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6OToiaGVhbHRoYWZmIjtzOjU6InJlc2lkIjtzOjg6IjI0LzQvOTAzIjtzOjQ6ImF0b20iO3M6MjQ6Ii9jbWFqLzE3NC8xMS8xNTk5LjEuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9) 

4.  4. OECD health data 2004 [CD-ROM]. Paris: Organisation for Economic Co-operation and Development; 2004.