| Date Published: | September 1, 2001 |
| Author(s): | Michael Walker Greg Wilson |
| Research Topic(s): | Health Hospital Waiting Lists |
| The Fraser Institute's 11th annual waiting list survey found that waiting time for surgical and other therapeutic treatments grew significantly in 2000-01. Total waiting time between referral from a general practitioner and treatment, averaged across all 12 specialties and 10 provinces surveyed, rose from 13.11 weeks in 1999 to 16.2 weeks in 2000-01. This nationwide deterioration reflects waiting-time increases in eight provinces, while concealing decreases in waiting time in Saskatchewan and Newfoundland. Among the provinces, Ontario achieved the shortest total wait in 2000-01, 13.9 weeks, with Newfoundland (14.6 weeks) and Prince Edward Island (15 weeks) next shortest. Despite a very significant improvement, Saskatchewan exhibited the longest total wait, 28.9 weeks; the next longest waits were found in New Brunswick (25.8 weeks) and British Columbia (18.9 weeks). The first segment of waiting: Between referral by general practitioner and visit to a specialist for consultation The rise in waiting time between 1999 and 2000-01 is principally a result of an increase in the first wait, the wait between visiting a general practitioner and attending a consultation with a specialist. This waiting time grew from 4.91 weeks in 1999 to 7.2 weeks in 2000-01. The shortest waits for specialist consultations were experienced in Prince Edward Island (6.3 weeks), Saskatchewan (6.3 weeks), and British Columbia (6.5 weeks). The longest waits for specialist consultations occurred in New Brunswick (16.2 weeks), Nova Scotia (8.8 weeks), and Alberta (7.9 weeks). The second segment of waiting: Between the decision by the specialist that treatment is required and treatment Significant decreases in Saskatchewan, Newfoundland and Prince Edward Island disguise increases in the other seven provinces. Waiting time between specialist consultation and treatment–the second stage of waiting–increased for Canada as a whole between 1999 and 2000-01, rising from 8.21 to 9 weeks. The shortest specialist-to-treatment waits were found in Ontario (7 weeks), Nova Scotia (7.8 weeks), and Newfoundland (8 weeks), while the longest such waits existed in Saskatchewan (22.6 weeks), British Columbia (12.3 weeks), and New Brunswick (9.6 weeks). Waiting by specialty Among the various specialties, the shortest total waits (i.e., between referral by a general practitioner (GP) and treatment) existed for medical oncology (5 weeks), radiation oncology (8.9 weeks), and general surgery (9.2 weeks). Conversely, patients waited longest between a GP visit and ophthalmology (27.9 weeks), orthopaedic surgery (26.5 weeks), and plastic surgery (24.3 weeks) treatment. There was a striking increase between 1999 and 2000-01 in the wait for ophthalmology (+8.9 weeks), and neurosurgery (+4.5 weeks). These increases mask improvements for patients receiving treatment in otolaryngology (-4.2 weeks), urology (-1.1 weeks), gynaecology (-0.8 weeks), orthopaedic surgery (-0.6 weeks), and radiation oncology (-0.1 weeks). The wait for general surgery remained the same. 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 medical oncology (3 weeks), radiation oncology (3.1 weeks), and general surgery (3.6 weeks), while the longest waits are for neurosurgery (13.8 weeks), ophthalmology (11.6 weeks), and orthopaedic surgery (11.4 weeks). For specialist-to-treatment waiting, patients wait the shortest intervals for medical oncology (2 weeks), urgent cardiovascular surgery (2.8 weeks), and urology (4.7 weeks), and wait longest for ophthalmology (16.3 weeks), orthopaedic surgery (15 weeks), and plastic surgery (13.7 weeks). Comparison between clinically "reasonable" and actual waiting times In addition to actual waiting times for care, specialists are also surveyed as to what they regard as clinically "reasonable" waiting times. While these values by themselves do not reflect the state of actual waiting time, they can usefully be compared with actual waits. The comparison made is between reasonable and actual specialist-to-treatment waiting times for all 10 provinces and 13 specialties (both urgent and elective cardiovascular surgery are included); it reveals that out of the 121 categories (some comparisons were precluded by missing data), actual waiting time exceeded reasonable waiting time in 86 percent of them. Averaged across all specialties, Nova Scotia and New Brunswick came closest to meeting the standard of "reasonable" in that their actual specialist-to-treatment waits only exceeded the corresponding "reasonable" values by 49 and 64 percent, respectively, smaller gaps than in the other provinces. This partially reflects higher standards as to what is "reasonable" in a number of other provinces, such as Ontario, and Quebec. Among the specialties, "reasonable" was most often met or bettered for medical oncology and urgent cardiovascular surgery. 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 2000-01. Patients also experienced significant waiting times for various diagnostic technologies across Canada: computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound scans, although the median waits for all three technologies remained the same as in the Institute's 1999 survey. The median wait for a CT scan across Canada was 5 weeks. The shortest wait for computed tomography was in Nova Scotia (3.5 weeks), while the longest wait occurred in Prince Edward Island (10.3 weeks). The median wait for an MRI across Canada was 12 weeks. Patients in Manitoba experienced the shortest wait for an MRI (8 weeks), while Newfoundland residents waited longest (23 weeks). Finally, the median wait for ultrasound was 2.5 weeks across Canada. Saskatchewan displayed the shortest wait for ultrasound (2 weeks), while Manitoba exhibited the longest ultrasound waiting time, 8 weeks. Numbers of people waiting The numbers of people waiting for each procedure, and therefore each specialty, were also calculated. In 2000-01, a significant improvement in our methodology allows us to more accurately estimate the number of patients waiting for treatment. Throughout Canada, the total number of people estimated to be waiting for treatment was 878,088 in 2000-01, an increase of 3 percent between 1999 and 2000-01. The number of people waiting rose in New Brunswick, Alberta, British Columbia, Manitoba, and Ontario. As a percentage of the population, 2.82 percent of Canadians were waiting for treatment in 2000-01, which varied from a low of 1.84 percent in Prince Edward Island to a high of 7.21 percent in Saskatchewan. Verification of the data To attempt to corroborate the findings of this and previous surveys, current waiting time data were solicited from provincial governments, and past waiting time data were drawn from peer-reviewed journals. Provincial governments collect data that neither directly nor easily compares with that collected by our survey. Nonetheless, even evidence from British Columbia, the jurisdiction where the wait times collected by government most startlingly clash with those published in this study, add credibility to the Institute's estimates. The evidence from comparison with academic research strongly suggests that the Institute's measurements may be biased downward, understating actual waiting times. Summary: The magnitude of the problem and the importance of reform Canada-wide total waiting time increased significantly in 2000-01—and its level is high, both historically and internationally. Compared to 1993, waiting time in 2000-01 is 69 percent higher. Moreover, academic studies of waiting time have found that Canadians wait longer than Americans, Germans, and Swedes (sometimes) for cardiac care, although not as long as New Zealanders or the British. Waiting time has been found in medical research to entail adverse consequences for cardiac outcomes. Furthermore, economists attempting to quantify the cost of this waiting time have estimated it to amount to $1,100 to $5,600 annually per patient. The extent of Canada's health system dysfunction was documented in a 2000 Fraser Institute study examining the impact of increases in government health spending. This analysis revealed that provinces spending more on health care per person had neither shorter (nor longer) total waiting times than those spending less. In addition, those provinces spending more had no higher rates of surgical specialist services (consultations plus procedures) and had lower rates of procedures and major surgeries. Finally, the promise of the Canadian health care system is not being realized. On the contrary, a profusion of recent research reveals that cardiovascular surgery queues are routinely jumped by the famous and politically-connected, that suburban and rural residents confront barriers to access not encountered by their urban counterparts, and that low-income Canadians have less access to specialists, particularly cardiovascular ones, and have lower cardiovascular and cancer survival rates than their higher-income neighbours. This grim portrait is the legacy of a medical system offering low expectations cloaked in lofty rhetoric. Indeed, under the current regime–first-dollar coverage with use limited by waiting, and crucial medical resources priced and allocated by governments–prospects for improvement are dim. Only substantial reform of that regime is likely to alleviate the medical system's most curable disease—longer and longer waiting times for medical treatment. | |
| ISBN: | 4180-3666 |
| Type: | Studies & Reports |
| Free Download: | Download |
| Files: | Complete Publication |
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