Wait-time benchmarks fall short

New wait-time benchmarks announced Dec. 12 by the federal government were both lauded as a major shift in health care delivery and criticized for failing to set deadlines for implementation.

The announcement fulfils a promise made in the September 2004 federal/ provincial health accord to establish “evidence-based wait-time benchmarks” in 5 areas of care. The benchmark targets in all jurisdictions (except Quebec, which will develop its own plan) include: cancer radiation treatment within 4 weeks, hip fracture repair within 48 hours, hip and knee replacement surgery within 6 months, cataract surgery within 4 months for high-risk patients, breast cancer screening for women 50 to 69 every 2 years, cervical cancer screening for women 18 to 69 every 3 years; and cardiac bypass surgery within 2 to 6 weeks for those at high risk.

The announcement gives provincial governments another 2 years to set out their targets for implementing the guidelines. CMA President Dr. Ruth Collins-Nakai and spokesperson for the Wait Time Alliance (WTA) of Canada, said this deadline needs “revisiting.” In June 2004, the Supreme Court of Canada struck down a Quebec law prohibiting private health insurance coverage (the Chaoulli decision) for procedures the public system offers. A stay on that ruling will be lifted in June, and new wait times, says Collins-Nakai, must be in place to avoid re-opening the debate.

The WTA, which was set up by the CMA and 6 specialists' organizations, released benchmarks in August 2005 that are more ambitious in some areas than the new federal guidelines. For example, the WTA included a wait of no more than 10 days for cancer radiation therapy and stipulated a maximum wait time of 30 days for MRIs and CAT scans. Both of these diagnostic procedures were left out of the new federal guidelines, leaving a big hole, according to Normand Laberge, president of the Canadian Association of Radiologists, who points out that you can't have treatment without a diagnosis.

Collins-Nakai acknowledges that “Challenges certainly remain in some specific areas in the big 5, primarily in diagnostic imaging and certain aspects of sight restoration and cardiac services.”

Still she praised the federal and provincial governments “for working together for the sake of patients,” and said the benchmarks represent “a fundamental change to a patient-centred approach.”