The first major effort to compile comparable nationwide data on health services wait times suggests that skyrocketing demand in the so-called priority areas of cancer, heart, diagnostic imaging, joint replacements and sight restoration hasn't appreciably lengthened the time it takes to get treatment.
But Canadian Institute for Health Information (CIHI) officials are quick to caution that conclusions drawn from its recent report, Waiting for Health Care in Canada: What We Know and What We Don't Know are suspect because of data collection and methodological issues.
“We do not have a comprehensive, cross-Canada picture,” said CIHI Chair Graham Scott, at a Mar. 7 press conference. “But our expectation is that there will be better, more comparable data in the future.”
CIHI President Glenda Yeates says the data are highly variable because of factors ranging from physician practice patterns, referral procedures and things like “what type of care you need, whose list you are on and where you are waiting, how processes of care and wait lists are managed and special factors related to individual patients or conditions.”
“There is no average person or average wait,” Yeates says.
This is the first time comprehensive wait time data has been compiled, and without a valid reference point it's impossible to conclude whether the situation is improving, Scott said in an interview. “But the one thing we can do is show that there's been a huge increase in volume and the wait times don't seem to have gotten worse, so if there's a positive message, I suppose that's positive.”
Scott stressed the need for more standardization of the way wait times are measured across Canada. “In the vast majority of the country, wait times are controlled by individual physicians. So until the system and the physicians cooperate and pull that all together, which they've done in some places like the Alberta Bone and Joint Institute, and so on, it's very hard to begin to measure some of these things, let alone how each one of those physicians measures it.”
The report indicates explosive demand for services, including a 51% increase (by 22 000 cases) between 1998–2003 in the number of cardiac bypass surgeries and angioplasties; a 30% hike (up 11 340) in knee and hip replacements; and a 32% increase (62 000 cases) in cataract surgeries (Fig. 1).
Overall, the report projects roughly half of all patients wait less than 30 days for non-emergency surgery, with hip and knee replacements taking much longer, typically 3 months. Roughly 10% of all patients wait at least 6 months for treatment.
The report also indicates that queues to see a specialist are typically long. In the case of hip and knee replacement patients, often 30% of the overall wait time is spent waiting for the initial visit with an orthopedic surgeon.
Mike McBane, executive director of the Canadian Health Coalition, a pro-medicare lobby, expressed concern that the focus on wait times is deflecting attention from needed systemic changes.
“We're getting a partial picture of less and less,” McBane said. “We're going backwards. Instead of moving to reform the system, moving to prevention, moving to home care, we're going back to fixation on a few high tech procedures of acute care. But what about the whole system?”