VANCOUVER—In constant pain and facing a wait of 18 months to two years for hip replacement surgery, Pamela and Cliff Jansen took their health care into their own hands.

The North Vancouver couple, both suffering from osteoarthritis, decided last fall to go to Belgium for their operations, renegotiating their mortgage to pay the $35,000 tab.

Today, the Jansens consider it the best investment they've ever made. Each has full range of motion and flexibility and they resumed recreational ice dancing months ago.

"It's all back the way it was 10 years ago," says Pamela, 54. "It's unbelievable. I've been grinning non-stop for the past 13 months."

The Jansens know nearly a dozen other people in British Columbia who have followed their lead and travelled to Belgium for the surgery. In addition to having it done quickly, the Belgian procedure is believed to offer the Jansens a much more durable joint than they would have received in Canada.

Although there is no one agreed-upon method of calculating the wait patients face for specific medical procedures, few health-care experts dispute that they're too long. And, with more baby boomers reaching their 50s and beyond, the number of people requiring these services is only going to increase over the next couple of decades.

"We have a lot of frustrated people who are waiting in pain needlessly," says Bill Langlois, executive-director of the Arthritis Society for B.C. and Yukon.

In addition to average waits of up to 18 months for a hip or knee replacement, Langlois says it can take up to a year to see a surgeon just to get on the list.

According to a survey last month by the Vancouver-based Fraser Institute, hospital waiting times in Canada have almost doubled over the past decade. Ontario residents fared best with a median wait of 14.3 weeks for all types of operations (half the people got the surgery in less than 14.3 weeks, the other half waited longer). Saskatchewan was the worst with an average wait of 29.9 weeks.

In Western Canada, Manitoba at 15.1 weeks and British Columbia at 17.6 weeks were the only two provinces to fall under the national average. Albertans wait 18.5 weeks.

George McGill is an anguished face behind those statistics. The 54-year-old uses crutches with a special knee brace and has been taking up to a dozen painkillers a day since he first went on the surgery waiting list 15 months ago.

"It's been hell," says McGill, a sales manager with a distribution company, who is finally scheduled for a knee replacement next week. "Why should people have to wait so long in our country when we're supposed to have one of the best medical systems going?"

`We have a lot of frustrated people who are waiting in pain needlessly' Bill Langlois, Arthritis Society

It's a question Dr. Ken Hughes has heard more often in the past few years. About 9,000 people in B.C. are now waiting for knee and hip replacements and the total is increasing by 10 per cent annually. But there's funding for just 6,000, meaning an 18-month wait.

Those figures will get worse unless funding is increased or patients are allowed to participate in what Hughes, president of the B.C. Orthopedic Association, calls "queue-sharing."

Such a plan is a modification to so-called health-care guarantees proposed by Senator Michael Kirby in his review of medicare last year. Under the plan, if a patient doesn't receive treatment for a particular procedure within a set time, he or she is entitled to get it done in another jurisdiction — including the United States — at public expense.

Hughes said under his plan a person who could afford to pay would shell out double the fee for an operation to get it done quickly here. One half of the patient's payment would pay for his or her procedure, the other would pay for the surgery for another patient on the list.

"There's no question that queue-jumping is going to hurt the people who can least afford it," says Hughes, who recognizes his proposal is controversial because it requires altering the Canada Health Act. "But in queue-sharing, a person, for an extra price, pays for two. I don't see a downside in that."

But Stephen Howard, spokesperson with the B.C. Hospital Employees' Union, says he does.

"People believe in their public medicare system, oppose privatization and do not believe that access to care should be determined by the size of your wallet," he says.

Howard's union has been leading the opposition to the B.C. government-sanctioned move by the Vancouver Coastal Health Authority to contract out to private clinics dozens of procedures normally done at the Richmond Hospital, including cataract removal, breast biopsy and knee arthroscopy.

Premier Gordon Campbell says the plan may help reduce wait times for some surgeries but critics say it's just another example of his government's rush to embrace private care.

All Cliff Jansen, 45, knows is that he and his wife were not about to let their lives pass them by while the debate over how to cut Canada's waiting lists rages on. But they also know that the best solution for their pain — and that of thousands of others — is to fix the country's health-care system so people get what they need on time and at home.

"We feel we spent the best money we ever spent in our lives," says the computer software engineer.

"The only silly thing was we had to go out of the country to do it."