September 28th 2011: With the wave of Provincial elections set to sweep the country this Fall, the healthcare debate is heating up and it’s a good time to take stock of what’s been achieved.
As Susan Eng, CARP VP of Advocacy points out: “Elections should be a time of assessment and change – of monitoring where we are and where we’d like to be heading.”
Thus, the Wait Times Alliance’s latest report “Time Out: A Report Card of Wait Times in Canada” (June 2011) comes at the perfect time to take stock of how the provinces are performing (or not) in key areas. Unfortunately, as the expiry of the 10-Year Accord to Strengthen Health Care draws near, long waits for care still threaten the ability of Canadians to get timely access to quality health care services.
The Canada Health Accord originally set out five priority areas for wait time benchmarks – Diagnostic Imaging, Joint Replacement, Cancer Care, Sight Restoration and Cardiac Care. In addition to emergency care, the coalition group subsequently identified five additional wait time benchmarks for psychiatric care, gastroenterology, plastic surgery, and anesthesiology.
Since 2005, the Wait Time Alliance (WTA) has been issuing reports on Canadians’ access to timely specialty care. The WTA is a group of twelve medical associations including the Canadian Medical Association and is a very important pan-Canadian player in developing benchmarks and assessing progress on wait times. Over time, the Wait Time Alliance has broadened its focus beyond the initial five priority areas, and now reports on several areas of specialty care and the total wait facing patients. It has proposed benchmarks for a number of procedures based on the advice of clinical experts and on research evidence.
Another timely aspect of this report is that highlights the serious detrimental impact alternate-levels-of-care (ALC) stays are having on wait times for both emergency and elective/scheduled care. According to the WTA, the high number of hospital patients waiting for alternative levels of care such as rehabilitative or long-term care is the single-biggest cause of longer wait times! They say as many as one in six hospital beds are occupied by patients who should be receiving care somewhere else. To read our article on ALC beds and ER wait times, please click here.
As in the WTA’s five previous annual report cards, provinces and territories have shown modest improvement in reducing waits endured by patients in the five clinical areas governments consider a priority. The WTA evaluates the progress all governments have made in the original five key areas over the past 5 years as an overall “B”. Ontario, Quebec and BC get top marks in this area whereas Nova Scotia and Alberta were said to be lagging.
In all fairness it’s very difficult for them to evaluate the rest because beyond the five priority areas governments are reporting on just 10 per cent of the important procedures selected by the WTA.
There is, however, some good news: they anticipate wait times data will improve in the near future because all provinces now having a wait-time website. While progress has been achieved in increasing accountability to the public, there remains considerable room for improvement in how many services are reported on and in the provision of more precise data.
The Health Council of Canada paints a somewhat different picture of wait times. Citing the Canadian Institute for Healthcare Information (CIHI), their recent report states that 8 out of 10 Canadian patients are treated within the pan-Canadian benchmarks announced by governments in 2005 but that the likelihood of receiving care within these timeframes varies by procedure and by hospital.
It is also important to note that although provincial governments sing their own praises when they achieve these benchmarks, it’s important that we, the public, keep them on their toes. The original benchmarks set by the WTA and provinces should be seen as maximum acceptable wait-time targets or at best initial targets. Whether or not all of these benchmarks are even appropriate is debatable: the wait time benchmark for elective heart bypass surgery is a whopping 182 days while the Canadian Cardiovascular Society recommends that the benchmark be brought down to 28 days!
Honourable mentions go to Ontario, Alberta, Nova Scotia, BC and Saskatchewan for reporting the greatest number of treatments beyond the five priority areas. Unfortunately, the WTA finds the lack of reporting on wait times for such important substantial fields as gastroenterology, psychiatric services and chronic pain anesthesiology unacceptable.
Overall grade: “B”
Heat Bypass Surgery: “A”
Knee Replacement: “C”
Hip replacement, radiation therapy and cataract surgery: “B”