Wait times: So much money, such modest progress

TheGlobeandMail.com – news/opinions/opinion
Published Friday, May. 27, 2011.    Jeffrey Simpson, Columnist

Seven years and billions of dollars later, what’s up with wait times in Canada? Or perhaps we should ask, what’s down with wait times, because on average, they have declined somewhat since the federal and provincial governments began throwing money at five procedures.

The declines have been extremely modest, especially in relation to the money spent to reduce them. The money went only to five procedures representing about 8 per cent of all surgical procedures pursuant to the 2003-2004 health accord that offered up an additional $41-billion, indexed annually at 6 per cent, some of which was targeted to reduce wait times. And then there was the politically useful but operationally useless Conservative election promise of a Patient Wait Time Guarantee in the 2006 election.

During the recent election campaign, the parties hurriedly pledged to extend that 2003-2004 accord – set to expire in 2013-2014– without giving any thought whatsoever as to why or how the money should be spent.

The Famous Five procedures are knee and hip replacements, hip fractures, cataracts, cardiac bypass, radiation for cancer – all treatments overwhelmingly needed by the elderly, who consume the largest share of health-spending.

There’s plenty of anecdotal evidence that by putting so much emphasis on the Famous Five, wait times got longer for other procedures, for which operating-room time became even harder to find. Hence the staggeringly long wait times for such orthopedic procedures as spinal, ankle and foot surgeries recently reported in The Globe and Mail.

Provinces worked out benchmarks for wait times for the Famous Five based on medical evidence of need: a median time within which 90 per cent of patients were to be treated. The benchmark for hip and knee replacements, for example, is 182 days.

Wait time benchmarks were calculated to be quite generous to governments. For example, governments measured the time from booking surgery to the procedure. They did not count the wait time to see a family doctor, and then to see a specialist or a surgeon. Including these wait times along the continuum of care would have presented a much gloomier picture. (The Fraser Institute’s annual survey of wait times uses different measurements and produces a much darker picture.)

According to the Canadian Institute for Health Information, provinces have made some progress in getting these five procedures for more patients within the benchmark times for surgery. Eight out of 10 Canadians are getting these procedures done within the benchmark times.

No province, however, has completely met the benchmark targets after all these years and all that money. Some of them – notably the three Prairie provinces and the Atlantic Canadian ones – are very far away from meeting them.

Wealthy Alberta, for example, has over 90 per cent of patients meeting benchmarks for bypass and radiation, but has only 48 per cent of cataract patients within the benchmark and 69 per cent for knee replacements. Nova Scotia is great for bypasses – 100 per cent – but terrible for hip and knee replacements, 57 and 42 per cent.

According to CIHI, the worst trend lines are in Alberta and Manitoba; the best would seem to be in Ontario and British Columbia. Since all governments have been increasing spending on health care generally at 5 to 6 per cent annually, money alone can’t answer why some provinces are making more progress than others. Nor can it explain the very spotty progress across the country.

CIHI concluded, “while there have been some improvements in wait times for priority area procedures over the last three years, these improvements are not being seen consistently across all procedures or across all provinces.”

That’s a disturbing conclusion, given how much money governments are pouring into these five procedures. Surely Canadians had a right to expect that better results would flow from so much additional money over so many years. And no one has calculated precisely what the effect of that focused spending has been on other procedures not included in the Famous Five.

It’s not surprising, therefore, that a study of 11 countries cited by CIHI found that Canadians were more likely than people in other countries to be unhappy about wait times to see a doctor, getting after-hours care and procedures for elective surgery.

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