Wait Times in Canada – Transformation is imperative

The Wait Time Alliance (WTA) has once again released their Report Card on Wait Times in Canada, and the outcomes are disappointing. Over the past several years, the Wait Time Alliance has been reporting on provincial performance on achieving wait time benchmarks for cancer, cardiac care, diagnostic imaging, joint replacement, and sight restoration, while challenging provinces to improve.

Despite its efforts and the growing attention on improving health care systems and access to care, there has been little progress in reducing wait times. However, beyond the disappointing news, this year’s Report Card calls for major transformation and recommends that provinces make structural changes that will be more likely to reduce wait times.

Lack of progress in reducing wait times

The WTA 2013 Report Card reveals that Canadians continue to wait longer than people in most other industrialized countries with public systems. Although provinces have shown small improvements, there was little overall progress. The report reveals that current efforts only aim to reduce the wait time between the decision to treat and the start of treatment. And they ignore the long wait time to see a consulting specialist, a step that is required to reach a decision to treat. Since little work has been done to measure this step, little is known about the length of time patients wait to see a specialist in the first place. As a result, current efforts are making little difference to the total wait times experienced by patients.

More funding may not be the answer

Often insufficient funding is identified as one of the major factors contributing to long wait times. However, the WTA 2013 Report Card states that additional funding cannot be the sole solution. Referring to an OECD study, additional funding had only a temporary effect where it was applied and once the funding decreased, wait times lengthened again. As provinces are under serious fiscal constraints, the WTA report offers hope that there are alternatives to more spending.

Major transformation is needed through structural changes

The WTA report recommends major transformation to address long wait times. It recommends structural and systemic changes in how wait times are mitigated, measured, monitored, and managed:

• Redirect and optimize resources –Funding models for hospitals can be improved to increase incentive to provide more services more efficiently. For example, hospitals can use activity-based budgeting rather than its current global budgeting as it is currently done in Canada. The activity-based budget would attach funding to specific activities, providing a greater incentive to do more treatments and procedures, and as a result, achieve better patient outcomes.
• Adopt and enforce guidelines and standards –Wait-time guarantee targets can be adopted, which should have consequences if not met.
• Measure and report indicators – Hospital performance and wait times can be made available to patients so that patients can have the option to find alternative providers with shorter wait times. Tools to measure and guide clinical prioritization and appropriateness can be implemented to better address and prioritize patient needs.

A Canadian example of structural change is the Canadian Paediatric Surgical Wait Time Project. The project developed and implemented a common methodology to measure, monitor, and manage surgical wait times so that there is consistency across Canada. Under this methodology, children with the same diagnosis are given the same priority wherever they are in Canada, which has helped to keep wait times consistent across the country. There is a central database with wait time data and trends and the system provides actionable management information to improve access to surgical care. As a result, the system and its standards have led to reduced percentage of children waiting for treatment.

Provinces must put the patient at the centre

The transformation that the WTA calls for aligns with CARP’s One Patient model. CARP has also been calling for a system that is patient-centered, where the system is designed to prioritize the patient’s needs in a seamless and integrated fashion. CARP believes that this can be achieved with existing resources through better management and redirection of resources, enforcement of standards, monitoring and reporting, and cross-discipline coordination and communication.

Canadians are not necessarily looking for more funding but better outcomes that will address their needs today. The data from the WTA 2013 Report Card shows that not only is the system not changing enough but it is also being outpaced by growing patient needs. This is the message that CARP will be bringing to all provincial Health Ministers across the country, emphasizing the need for real transformation so that patients will no longer wait unduly for necessary diagnosis, referral, and treatment.

Read the full Wait Time Alliance 2013 Report Card.

Read CARP’s One Patient Brief.

 

June 14, 2013