Questioning success on health care wait times

A Canadian Institute for Health Information (CIHI) study recently reported that wait times for access to health care across a few priority treatment areas are improving. According to CIHI, “at least 8 out of 10 Canadian patients are receiving priority area procedures… within medically recommended wait times.” This score might be acceptable to those who manage the health care system, but patients and taxpayers would be justified in questioning whether it represents success for them.

If eight of 10 patients receive treatment within government targets, then about 20 per cent of patients didn’t get access within those targets. How many people is this? According to the report, “in 2010–2011, hospitals performed about 400,000 surgical procedures across the priority areas: hip and knee replacements, hip fracture repairs, bypass procedures and cataracts.” Assuming one procedure per person means that up to 80,000 Canadians in 2010-2011 didn’t get access to these priority treatments within the target wait times.

In 2004, federal-provincial-territorial first ministers agreed upon “a 10-year plan to strengthen health care” that included a wait time reduction strategy. If roughly 20 per cent of patients annually wait longer than the target period, then at least 480,000 people have been affected by serious delays across these priority areas over the six years between 2004 and the end of the study period in 2010.

How much more did it cost to achieve this magnificent result? According to the federal Department of Finance, the 10-year plan increased existing federal health transfers by $41.3 billion in new funding, including an automatic escalator of six per cent annually to the new base of federal funding. An additional $5.5 billion was invested over a 10-year period specifically to help reduce wait times. In addition to hundreds of billions of dollars already spent annually by governments on health, the 10-year plan added $47 billion dollars more in federal spending and still, almost 20 per cent of patients can’t access treatment within government-defined targets - and that’s just across a few priority treatment areas.

What about non-priority treatment areas? According to CIHI, the surgical procedures included in their report “represent about one-eighth of all those performed in Canada”, therefore nearly 88 per cent of surgeries are outside the priority areas. Further, CIHI only measures the waiting period between consultation with a specialist and the time at which the patient receives treatment from a specialist. CIHI’s study does not measure wait times to see a general practitioner (GP), the subsequent waiting period between GP referral and specialist consultation, or the separate waits for diagnostic services. This is a lot of waiting governments have conveniently chosen not to measure.

More comprehensive data are available for wait times. The Fraser Institute annually surveys physician specialists across the country about wait times in 12 medically necessary treatment areas. In 1993, physicians reported that the average median wait time between the point at which a patient gets a referral from a general practitioner and actually receives specialist treatment was 9.3 weeks. By 2010, this waiting period had nearly doubled to 18.2 weeks. The survey estimates that 825,827 patients were waiting for treatment in 2010 across these 12 specialties.

It is worth asking whether the government-defined targets for waits in the priority areas are reasonable. According to Health Canada, “evidence-based benchmarks for medically acceptable wait times” were to be established by the ministers of health. The ministers eventually settled on wait targets of 26 weeks for hip replacements and knee replacements; 26 weeks for cardiac bypass surgery “depending on how urgently care is required;” 16 weeks for cataract surgery, but only for “patients who are at high risk;” and 4 weeks for radiation (cancer) therapy – measured from the point at which patients are “ready to treat.” It is hard to confirm the degree to which such wait targets reflect a genuine consensus of medical research or just the opinion of the panel who advised the health ministers.

In any case, these targets do not consider what patients themselves might think is a reasonable wait, which should be important, given that it is patients who bear the risks to their personal health, their physical discomfort, and the loss of their personal productivity while remaining untreated. In the current health system, no one knows or cares how long patients prefer to wait. The allocation of medical resources is a political-bureaucratic decision in Canada, not a consumer choice.

Canadians should be asking their governments why any delays to accessing necessary medical care are acceptable. Research consistently shows that there are little or no reported waits in the Netherlands, Switzerland, Luxembourg, Belgium and Germany – all of which have the same social goals as Canada: universal access to health care.