National wait time standards remain elusive

National standards for acceptable wait times in 5 priority categories of medical treatment dominated discussions when provincial and territorial health ministers met Health Minister Ujjal Dosanjh in Toronto in late October. But after 2 days of wrangling it seemed clear that comprehensive national guidelines would themselves require a lengthy wait.

The federal and provincial ministers pledged to meet a year-end deadline for setting “evidence-based benchmarks” for some types of diagnostic imaging, joint replacement, cancer treatment, cardiac procedures and cataract surgery, and agreed to work toward more comprehensive national standards, said Dosanjh.

The provinces had already promised to do this as part of the federal government's 10-year plan to strengthen health care, negotiated in September 2004. That agreement also saw the federal government commit $41 billion in new health care money, much of it delivered through the provinces.

But not all in attendance echoed Dosanjh's optimism. Speaking to CMAJ after the meeting, BC Health Minister George Abbott suggested that, although the decision to establish “some benchmarks in some areas” was a promising preliminary development, it could be as long as 5 years before Canada establishes a comprehensive framework.

“This is an evolutionary area of public policy,” Abbott said.

Ontario Health Minister George Smitherman also expressed doubts about the timetable. While acknowledging that “it's easy to be cynical” about the ministers' commitment to an unspecified number of wait-time benchmarks within the 5 priority categories, he told reporters that pressure for benchmarks may be the result of a “manufactured argument.”

Patients' demands for national guidelines have been exaggerated, Smitherman said. Even so, he stressed that Canadian politicians feel a political duty to deliver on their promise.

“We identified and campaigned on this issue to the people of Canada,” he acknowledged.

While defending their decision not to identify the specific treatments for which national wait-time guidelines will be issued by Dec. 31, Dosanjh, Smitherman and Abbott strongly insisted they require more research and more evidence before establishing standards.

That suggestion worries CMA President Ruth Collins-Nakai, who is a spokesperson for the Wait Times Alliance, an association formed by the CMA and 6 other medical associations.

In an August report, the Alliance recommended wait-time benchmarks for 18 specific treatments within the 5 priority categories, based on reviews of available evidence by teams of Canadian physicians.

“We take issue with the ministers' argument there's not enough evidence available to table wait-time benchmarks for numerous specific treatments right now,” says Collins-Nakai. “It worries me that they continue to weasel out of it.”

Appeals to present the Wait Times Alliance study to the ministers when they met in Toronto went unanswered. The ministers also failed to take up the Alliance's recommendation that $3 billion in new money be allocated to the provinces and territories to reduce wait times.

Even so, Collins-Nakai says she's “cautiously optimistic” that the provinces and the federal government are focusing on wait times, and that physicians' views will be reflected in the benchmarks. They are to be made public before December 31.

“We worked hard to put the issue of waiting time in front of the first ministers when they signed the 10-year plan last year, and we think our views were heard,” said Collins-Nakai. “I'm going to give them the benefit of the doubt they're still listening.”