June 9, 2011 – Progress towards better healthcare is difficult to measure, according to a report released by the Health Council of Canada. What’s more, progress on national benchmarks for quality, such as wait times, are mostly made locally and provincially, despite ever growing healthcare budgets and federal transfers.

Annual health care spending by provincial and territorial governments has increased by about $40 billion since the current Health Accords were signed in 2004, according to a new report from the Health Council of Canada (HCC). Total annual spending by the provinces and territories on health care rose from $85 billion in 2004 to a projected $125 billion in 2010, for an average annual increase of 6.7%.

Over the same period, federal transfer payments for health care – money the federal government gives to the provinces – have also increased. In 2005, the federal government allocated $19 billion to the Canada Health Transfer for annual cash payments to health care. This transfer has increased by 6% per year, which will continue through 2014, when the next set of Health Accords are negotiated with the provinces.

Has Quality Improved With Increased Spending?

The HCC report measured progress on a variety of fronts, including wait times and electronic health records. Where progress has been made, it tends to be localized and varied across the provinces and territories. In short, the report doesn’t tell us the overall progress of the healthcare system. Instead, the report notes that some areas within some provinces have improved, while others haven’t, or can’t properly be assessed.

Wait Times

With support from a $5.5-billion Wait Times Reduction Fund, the HCC report finds that governments have tackled long waits in a number of ways, including:

paying hospitals to perform additional procedures;
establishing specialty clinics to address backlogs for certain procedures;
and receiving input from physicians.

According to the report, early efforts to cut wait times focused on surgery. In the last few years, however, notable progress has been made in expanding wait times management beyond the five standard clinical areas (cancer, heart, diagnostic imaging, joint replacements, and sight restoration). A number of provinces have since set wait time benchmarks for areas such as emergency care and other types of surgery.

The bottom line, according to the report, is that governments have taken concerted action to reduce wait times, but signs of progress are not entirely clear. The amount of time you wait depends on where you live and what sort of care you require. For example, wait times for knee replacement surgery has decreased in Saskatchewan but increased in Manitoba, while they’ve remained the same in Ontario.

Wait times are complex due to local factors and the “dynamic nature of supply and demand in health care”. The report tells us that eight out of 10 Canadian patients are treated within the pan-Canadian benchmarks announced by governments in 2005 (for hip and knee replacement, hip fracture repair, cataract surgery, radiation, and bypass surgery), but the likelihood of receiving care within these timeframes varies by procedure and by hospital.

E-Health Records

In 2009, “the federal government allocated $500 million to Canada Health Infoway for electronic health initiatives. In total, the federal government has contributed $2.1 billion to the initiative. When matching funds from the provinces and territories are included, the total grows to nearly $4 billion”, according to the HCC report.

By the end of 2010, an e-health record was available for almost 50 percent of Canadians. “As of April 2011, the core databases that make up electronic health records were available for use by health care providers for all residents of British Columbia, Alberta, and Prince Edward Island, and some residents of Saskatchewan, Manitoba, Ontario, Quebec, New Brunswick, and Newfoundland and Labrador.”

Nine jurisdictions have at least four of the six core databases (client registry, provider registry, diagnostic images, laboratory test results, drug information systems, clinical reports/immunization) in place.

The bottom line, according to the report, is that while governments have made advances in electronic health record infrastructure, the technologies are still largely passive. A growing number of records may be stored electronically, but more doctors need to begin using e-health in daily practice. As it stands, there isn’t yet a common and cost effective way for doctors to implement and use e-health technologies. Likewise, governments need to get better at articulating just how e-health will help improve healthcare practices, care, and spending.

Saskatchewan, for one, has tasked the newly formed Treasury Board Crown corporation with overseeing the development and implementation of the province’s electronic health care system, the goal of which is to have an “electronic health record for each patient, to help ensure continuity of care across health care providers, improve patient safety, allow for e-prescribing, and improve chronic disease management.”

The Final Analysis

Overall, the report finds that provinces have taken important steps towards meeting goals that were established during the 2004 health accord negotiations. Nevertheless, results are mixed and progress is difficult to measure. Part of the difficulty may be selecting criteria by which to judge progress. The report doesn’t include details on the methodology used to measure progress.

According to the HCC, however, gauging national progress is difficult since progress tends to occur at the hospital, local, or provincial levels. Even where provinces and territories are pursuing similar goals, the report notes, they are generally doing so independently of each other: “Progress has been made by all the jurisdictions in particular areas, depending on their own priorities.”

In other words, in some areas, measurable progress was made and in others the results of attempted progress are difficult to measure. As the report states, “progress never stops, nor is it linear”.

The report urges governments to spend the next few year s – until the negotiations of the next health accords – focusing on concrete benchmarks in areas such as home care integration with primary care and achieving quality across the system, not just in localized areas.

The first round of benchmarks was a step in the right direction, as the report states, “the next push lies in having all governments work together—across the full spectrum of health care—in the interests of all Canadians, which was the real promise of the accords.”

To read the full report, click here

Keywords: healthcare, costs, wait times, records, treatment