Canadians are waiting longer than ever for medical treatment. Waiting times for surgical and therapeutic services in Canada have increased 7.3 percent over last year, according to The Fraser Institute's 13th annual survey, Waiting Your Turn: Hospital Waiting Lists in Canada, released today.

The total waiting time for patients between referral from a general practitioner and treatment, averaged across all 12 specialties and 10 provinces surveyed, increased this year; rising to 17.7 weeks in 2003 (from 16.5 weeks in 2001-02).

"Canadians are waiting almost 18 weeks for essential medical care. And these lineups have almost doubled over the past ten years. The standard solution -- throwing more money at the problem -- is just not working. The federal and provincial governments are still failing to act in the face of international evidence that increasing patient options for private care reduces waiting times," said John R. Graham, the Institute's director of health and pharmaceutical policy research.

"Unfortunately, if the proposed National Health Council merely follows the harmful recommendations in the Romanow Report and increases centralized decision making in bureaucratic and political hands, the negative trends in waiting times will continue," he continued.

Other conclusions from Waiting Your Turn :

• Wait times rose for access to both GPs and specialists
  
• Over 90 per cent of waiting times are considered beyond clinically "reasonable" times
  
• Waits for magnetic resonance imaging (MRI), computed tomography (CT), and ultrasound scans also increased

Total Waiting Time

Total waiting time refers to the wait between visiting a general practitioner and actual treatment. This year's nationwide increase in total average waiting time reflects increases in seven provinces, with decreases in waiting time in British Columbia, Saskatchewan, and Manitoba.

Among the provinces, Ontario recorded the shortest total wait (14.3 weeks), with Manitoba (15.1 weeks) and British Columbia (17.6 weeks) next shortest. Saskatchewan has the longest total wait (29.9 weeks). The next longest waits were found in Newfoundland (21.8 weeks), and New Brunswick (21.1 weeks).

The rise in waiting time is the result of both an increase in the first component of waiting time -- the wait between visiting a general practitioner and attending a consultation with a specialist -- and the wait between consultation with a specialist and actual treatment.

The First Wait: Between General Practitioner and Specialist Consultation

The waiting time between referral by a GP and consultation with a specialist rose to 8.3 weeks, an increase of 14 percent over last year (7.3 weeks).

The shortest waits for specialist consultations were found in British Columbia (6.7 weeks), Manitoba (6.9 weeks), and Saskatchewan (7 weeks). The longest waits for specialist consultations occurred in Newfoundland (12.6 weeks), New Brunswick (11.8 weeks), and Alberta (10 weeks).

The Second Wait: Between Specialist Consultation and Treatment

Waiting time between specialist consultation and treatment -- the second stage of waiting -- increased for Canada as a whole between 2001-02 and 2003, rising from 9.2 to 9.5 weeks. Decreases in British Columbia, Saskatchewan, Manitoba, and New Brunswick disguise increases in six other provinces.

The shortest specialist-to-treatment waits were found in Ontario (7.1 weeks), Manitoba (8.2 weeks), and Alberta (8.5 weeks). The longest waits between specialist consultation and treatment are in Saskatchewan (23 weeks), Prince Edward Island (11.1 weeks), and British Columbia (10.9 weeks).

Waiting by Specialty

Among the various specialties, the shortest total waits (between referral by a general practitioner and treatment) existed for medical oncology (6.1 weeks), radiation oncology (8.1 weeks), and general surgery (10.3 weeks). In contrast, patients waited longest between a GP visit and orthopaedic surgery (32.2 weeks), ophthalmology treatment (30 weeks), and plastic surgery (28.6 weeks).

There was a striking increase from last year in the wait for ophthalmology (an increase of 3.4 weeks), otolaryngology (+1.8 weeks), and urology (+1.5 weeks). However, there were improvements for patients receiving treatment in radiation oncology (a decrease of 0.4 weeks), gynaecology (-0.3 weeks), and elective cardiovascular surgery (-0.1 weeks).

Breaking waiting time down into its two components, there is also variation among specialties. With regard to GP-to-specialist waiting, the shortest waits are found in radiation oncology (2.1 weeks), cardiovascular surgery (3.4 weeks), and medical oncology (3.5 weeks), while the longest waits are for ophthalmology (13.9 weeks), orthopaedic surgery (13.3 weeks), and neurosurgery (12.4 weeks).

For specialist-to-treatment waiting, patients wait the shortest intervals for urgent cardiovascular surgery (2.1 weeks), medical oncology (2.6 weeks), and internal medicine and urology (5.7 weeks), and wait longest for orthopaedic surgery (18.9 weeks), plastic surgery (17 weeks), and ophthalmology (16 weeks).

Waiting for Diagnostic and Therapeutic Technology

The growing waits to see a specialist and to receive treatment were not the only delays facing patients in 2003. Patients also experienced significant waiting times for computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound scans.

The median wait across Canada for a CT scan was 5.5 weeks. The shortest wait for computed tomography was in New Brunswick, Nova Scotia, and Newfoundland (4 weeks), while the longest wait occurred in Prince Edward Island (8 weeks).

The median wait for an MRI across Canada was 12.7 weeks. Patients in New Brunswick experienced the shortest wait for an MRI (8 weeks), while Newfoundland and Nova Scotia residents waited longest (24 weeks).

The median wait for ultrasound was 3.6 weeks across Canada. Both Saskatchewan and Ontario had the shortest wait for ultrasound (2 weeks), while Manitoba exhibited the longest ultrasound waiting time (8 weeks).

"Reasonable" and Actual Waiting Times Compared

In addition to actual waiting times for care, specialists are also surveyed as to what they regard as clinically "reasonable" waiting times. In 92 percent of the 118 categories surveyed (some comparisons were precluded by unavailable data), actual waiting time exceeded reasonable waiting time.

Averaged across all specialties, Manitoba and New Brunswick came closest to meeting the standard of "reasonable" waiting times.

Numbers of Procedures for Which People are Waiting

Throughout Canada, the total number of estimated procedures for which people are waiting was 876,584 in 2003, an increase of 3 percent from the estimated 852,308 procedures in 2001-02.

The number of procedures for which people were waiting rose in Alberta, Ontario, Quebec, Nova Scotia, Prince Edward Island and Newfoundland.

Assuming that each person was waiting for only one procedure, 2.8 percent of Canadians were waiting for treatment in 2003, which varied from a low of 2.1 percent in Newfoundland and Ontario to a high of 7.7 percent in Saskatchewan.

The survey also asked physicians what percentage of their patients received non-emergency medical treatment outside of Canada. The highest percentage of patients seeking treatment outside of Canada were those in need of neurosurgery (2.1 percent). For all specialties, 1.4 percent of patients left the country to receive treatment.

New This Edition -- National Psychiatry Waiting List

In response to public demand, this year's edition of Waiting Your Turn measures Canadians' waiting times for psychiatric services such as psychotherapy, marital therapy, and prescription drugs for mental health. Although these measurements will be refined in future editions, the first year's results indicate that these waiting times are also unreasonably long.

Overall, the waiting time to see a psychiatrist on an urgent basis was 2 weeks, both for Canada as a whole and in most provinces. The waiting time for referrals on an elective basis was 8.5 weeks. The longest waiting times for elective referrals was in New Brunswick (20 weeks), followed by Saskatchewan (12 weeks), and Newfoundland (10 weeks). The shortest wait for an elective referral was in Manitoba (6 weeks).

Waiting Your Turn -- Methodology

The Fraser Institute's annual Waiting Your Turn survey presents the only comprehensive measure of hospital waiting times across Canada. The survey measures the extent to which queues for visits to specialists and for diagnostic and surgical procedures reflect health care rationing in the provinces. Information for the survey was provided by 2,817 specialists nation-wide in early 2003. An additional 663 psychiatrists responded to the new psychiatric survey.

The number of procedures for which patients are waiting reported in earlier editions of Waiting Your Turn have been restated for ease of comparison due to updates in the methodology used in these calculations.