July 27, 2012 – Wait times for critical medical procedures has not improved since last year, according to the Wait Time Alliance (WTA) 2012 national report card on provincial wait time performance. The report focuses on the five essential areas identified in the 2004 Health Accord: cancer (radiation therapy), heart (bypass surgery), joint replacement (hip and knee), sight restoration (cataract), and diagnostic imaging (CT and MRI).
Compared to last year’s results, this year’s wait times did not improve and furthermore, significant variation still remains across the country, illustrating the need to both improve access and uniformity across Canada.
In addition to the Health Accord’s five areas, the WTA addressed wait times for other necessary procedures and care issues such as public reporting quality on timely access, the causes of lengthy wait times, and best practices to improve wait times. The report graded each province based on the percentage of patients who are receiving treatment within the wait time benchmark. The report organized the results in six sections.
1. Performance of the five essential procedures identified in the Health Accords
Using the governments’ pan-Canadian benchmarks, there was no overall improvement in performance between 2011 and 2012, but rather provinces are backsliding. The report card revealed that only 13 areas improved compared to 24 in 2011. There were two instances where less than 50% of the population were being treated within benchmark compared to only one in 2011.
Cancer radiation therapy and heart bypass surgery
- received a national grade A for having more than 80% of Canadians treated within the benchmark
- best performance results nationally out of the five areas
- most provinces had no significant change, all received a grade A
Hip replacement and cataract surgery
- received a national grade B for having 70-79% of Canadians treated within the benchmark
- most provinces had no significant change
- PEI, Manitoba, and Nova Scotia lag in hip replacements
- PEI, Manitoba, Nova Scotia, and Saskatchewan lag in cataract surgery
- received a national grade C for having only 60-69% of Canadians treated within the benchmark
- most provinces are not adequately meeting the benchmarks
- PEI and Nova Scotia are lagging with less than 50% of their populations treated within the benchmarks
- only Ontario received a grade A with over 80% of its population treated within the benchmarks
Table 1: National performance of the five areas identified by the Health Accord.
|Procedure/treatment/service||Government pan-Canadian benchmark||National Grade|
|Cancer radiation therapy||
|Heart bypass surgery||
Grading methodology: A = 80-100% of population treated within benchmark
B = 70-79% of population treated within benchmark
C = 60-69% of population treated within benchmark
Ontario continued to perform the best, where it ensured all five areas had over 80% of population treated within the benchmarks. Alberta witnessed the most decreases in wait times whereas Manitoba witnessed the most increases in wait times.
The WTA also created their own benchmarks for many other procedures, stating that the Health Accord’s five procedures are too narrow. As a result, the WTA established wait-time benchmarks for 925 treatment, procedures, and diagnoses, many of which lacked provincial reporting. Therefore, the WTA urges improved collection and measurement of wait times for a wider spectrum of community, acute, and highly specialized services to ensure that Canadians have timely access to a full range of medical care.
2. Assessing Canadians’ total wait time to access necessary care
Current wait times do not consider the patient’s whole experience but only the portion between the specialist visit and the start of treatment as seen in Figure 1. It excludes the time it takes for a patient to find and be seen by a family physician along with the time to receive diagnostic intervention or be seen by a consulting specialist. The report states that these stages should also be considered in the overall wait time, especially since it found that the median wait times for a consult is longer than the median wait time for receiving procedures.
Figure 1: Wait times from the patient’s perspective
(Source: Wait Time Alliance Report)
1. Identifying regional variation in Canadians’ access
Although the assessment was completed at a province-wide level, the report recognized that significant variation exists among regions within provinces due to reasons such as lack of professionals, uneven demand, etc. However, the report calls for the identification of the causes of variation and the development of strategies to address shortcomings.
2. Grading provincial wait-time websites
The WTA assessed the provincial wait-time websites based on timeliness of website updates, comprehensiveness, patient-friendliness/accessibility, performance orientation, and quality/reliability. Despite room for improvement, the websites scored better this year and positive patient comments emphasized the importance of greater accountability and transparency in information dissemination.
3. Shedding more light on the impact of alternate levels of care (ALC) on wait times
Last year’s WTA report card stated that ALC issues need to be addressed to improve timely access to specialty care. Although there are numerous factors to the ALC issue, dementia was highlighted as one of the key contributors because dementia often leads to the loss of the cognitive ability to manage other chronic diseases. Destabilization of chronic diseases can result in increased emergency department use and hospitalization. Therefore, the report recommends community, acute, and long-term care approaches to decrease the impact of ALC on wait times, with more attention needed on the impacts of dementia on chronic disease management.
4. Highlight efforts by the WTA and governments to improve timely access to care
The report recognises that providing timely access to necessary care requires collaborative effort from health care providers, patients, and governments. There are examples of provinces taking steps to improve collection and reporting of wait times and adopting best practices from other provinces, which the report encourages the provinces to continue to do.
CARP has heard our members express concern about the undue hardship due to long wait times for treatment and necessary procedures. It is disappointing that the results of the 2012 WTA report card show Canada regressing in its wait time performance. Moreover, the national benchmark wait times appear to be very generous, yet we are still not meeting some of them.
There’s no doubt that improvement is needed. The report identified opportunities for improvement such as better data collection, benchmarking, and addressing direct underlying causes, such as dementia in the management of chronic diseases. However, as the Wait Time Alliance suggests, they may not be enough and it is time that we expand the wait time evaluation to a wider range of procedures, inclusive of the whole patient experience.
In submissions to government on chronic diseases and homecare, CARP’s advocacy focuses on integrating disparate health services to give patients a proper continuum of care, from diagnosis to treatment and after care. As for regional variation, the only way to fix the problem is for concerted national standards and action. Now that the Federal Government has walked away from the healthcare negotiating table, the provinces must take action to eliminate healthcare by postal code.