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ARTICLE |

British Columbia Sends Patients to Seattle for Coronary Artery Surgery: Title and subTitle BreakBypassing the Queue in Canada FREE

Steven J. Katz, MD, MPH; Henry F. Mizgala, MD, FRCPC; H. Gilbert Welch, MD, MPH
[+] Author Affiliations

Reprint requests to the Department of Internal Medicine, University of Michigan Medical Center, 3116 Taubman, Box 0376, Ann Arbor, MI 48109-0376 (Dr Katz).


JAMA. 1991;266(8):1108-1111. doi:10.1001/jama.1991.03470080078033
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Concern about waiting lists for elective procedures has become a highly visible challenge to the universal health insurance program in Canada. In response to lengthening queues for patients waiting for cardiac surgery, British Columbia made contracts with four Seattle hospitals to send a total of 200 patients for coronary artery bypass surgery. This article examines the cause of the queue for cardiac surgery in British Columbia and the events that led to outside contracting. Global hospital budgets and restrictions on capital expansion have limited hospital capacity for cardiac surgery. This constrained supply, combined with periodic shortages in critical care nurses and cardiac perfusion technologists, has resulted in a rapid increase in the waiting list. Reducing wide variations in the lengths of queues for individual surgeons may afford an opportunity to reduce long waits. While the patient queue for cardiac surgery has sparked a public debate about budget limits and health care needs, its clinical impact remains uncertain.

(JAMA. 1991;266:1108-1111)

REFERENCES

Le Bourdais E.  Will the BC contract wrangle ever end? Can Med Assoc J . 1990;;143:306-308.
Evans RG.  The fiscal management of medical technology: the case of Canada.  In: Banta HD, ed. Resources for Health: Technology Assessment for Policy Making . New York, NY: Praeger Publishers; 1982;.
Report to the Ministry of Health of British Columbia: Study of Cardiac Services of Open Heart Surgery, Percutaneous Transluminal Coronary Angioplasty and Coronary Angiography Provided in British Columbia . Toronto, Ontario: Keon & Menzies Inc; 1988;.
Alderman EL, Bourassa MG, Cohen LS, et al.  Ten-year follow-up of survival and myocardial infarction in the randomized Coronary Artery Surgery Study. Circulation . 1990;;82:1629-1646.
 The Veterans Administration Coronary Artery Bypass Surgery Cooperative Study Group. Eleven year survival in the Veterans Administration randomized trial of coronary bypass surgery for stable angina. N Engl J Med . 1984;;311:1333-1339.
Passamani E, Davis KB, Gillespie MJ, Killip T.  A randomized trial of coronary artery bypass surgery: survival of patients with low ejection fraction. N Engl J Med . 1985;;312:1665-1671.
Whalen R, Harrell FE Jr, Lee KL, Rosati RA.  Survival of coronary artery disease patients with stable pain and normal left ventricular function treated medically or surgically at Duke University. Circulation . 1982;;65:49-52.
Naylor CD, Basinski A, Baigrie RS, Goldman BS, Lomas J.  Placing patients in the queue for coronary revascularization: evidence for practice variations from an expert panel process. Am J Public Health . 1990;;80:1246-1252.

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Le Bourdais E.  Will the BC contract wrangle ever end? Can Med Assoc J . 1990;;143:306-308.
Evans RG.  The fiscal management of medical technology: the case of Canada.  In: Banta HD, ed. Resources for Health: Technology Assessment for Policy Making . New York, NY: Praeger Publishers; 1982;.
Report to the Ministry of Health of British Columbia: Study of Cardiac Services of Open Heart Surgery, Percutaneous Transluminal Coronary Angioplasty and Coronary Angiography Provided in British Columbia . Toronto, Ontario: Keon & Menzies Inc; 1988;.
Alderman EL, Bourassa MG, Cohen LS, et al.  Ten-year follow-up of survival and myocardial infarction in the randomized Coronary Artery Surgery Study. Circulation . 1990;;82:1629-1646.
 The Veterans Administration Coronary Artery Bypass Surgery Cooperative Study Group. Eleven year survival in the Veterans Administration randomized trial of coronary bypass surgery for stable angina. N Engl J Med . 1984;;311:1333-1339.
Passamani E, Davis KB, Gillespie MJ, Killip T.  A randomized trial of coronary artery bypass surgery: survival of patients with low ejection fraction. N Engl J Med . 1985;;312:1665-1671.
Whalen R, Harrell FE Jr, Lee KL, Rosati RA.  Survival of coronary artery disease patients with stable pain and normal left ventricular function treated medically or surgically at Duke University. Circulation . 1982;;65:49-52.
Naylor CD, Basinski A, Baigrie RS, Goldman BS, Lomas J.  Placing patients in the queue for coronary revascularization: evidence for practice variations from an expert panel process. Am J Public Health . 1990;;80:1246-1252.
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