A DIFFERENT VIEW OF QUEUES IN ONTARIO

Every health care system, regardless of how rich the country in which it operates, rations medical services, because no nation has the resources to match the insatiable demand for services. In the variety of approaches to rationing that nations employ, as David Naylor points out in this paper, the United Kingdom and the United States represent the extremes. Britain's National Health Service (NHS), which offers patients medical care that is free at the point of service, practices queue-based rationing. People face time delays before medical problems are addressed. In the United States, those with health insurance rarely have to wait long for treatment. But those without insurance have no ready access to care and must fend for themselves in public hospitals and other institutions prepared to accept charity cases. Canada prides itself on developing a health care system that strikes a middle ground. It is publicly funded and universally available, but care is privately provided. Administration and delivery of care are decentralized. But as demands for service have increased, Canada has resorted to rationing by queue for some procedures, such as cardiac surgery, for which demand exceeds supply. Naylor, an assistant professor on the faculty of medicine, University of Toronto (UT), holds a medical degree from UT and a doctoral degree in social and administrative sciences from Oxford Univeristy, where he was a Rhodes Scholar (1979-1983). In this paper, Naylor describes the rationing of coronary care in Ontario, Canada's richest and most populous province. He recounts the evolution of Ontario's crisis over growing waiting lists and how the system has addressed the problem. One fascinating dimension of rationing, Canadian style, is the interface between the media, who publicize the fate of patients who fall victim to the queues, and politicians, who respond to the resulting hue and cry in a way that underscores their accountability to the electorate.