Report reinforces Canada’s dire health-care wait times situation

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Appeared in the Vancouver Province, April 6, 2017

The Canadian Institute for Health Information’s [CIHI] annual tracking of wait times for priority procedures is out. Contrary to the CIHI news release’s sugar-coated headline that “[m]ost Canadians receive priority procedures within medically acceptable wait times,” the report is actually another reminder of how little has changed and how far we have to go.

While there’s value in CIHI’s measurement of wait times, its report focuses primarily on patient wait times for only five “priority procedures”, and that too in a very limited sense. For example, the report does not include the time it takes to get an appointment with a specialist and uses remarkably long benchmarks for acceptable time-frames (six months for hip and knee replacements, for example).

Even so, the report concludes that only three out of four Canadians received treatment within the medically recommended wait time. This means that one out of four Canadians—25 per cent—did not receive treatment within the generous benchmarks used in the report. Worse, the situation has deteriorated since last year when “only” one out of five Canadian patients—20 per cent—didn’t receive timely treatment.

More bad news: the report’s five-year trend analysis shows deterioration in access for three of five procedures (hip replacement, knee replacement and cataract surgery) since 2012. Only wait times for hip fracture repair have improved over the five-year period, although they were actually slightly worse in 2016 compared to 2015. In fact, the only legitimate silver lining is that between 97-98 per cent of patients consistently received radiation therapy treatment within 28 days.

So thankfully, patients waiting for cancer treatment seem to receive therapy within four weeks (not including delays in seeing the specialist).The remaining question is “what about everyone else?”

While governments in Canada still do not generally report comprehensive and inter-provincially comparable information on wait times for most medically necessary procedures, more detailed statistics are available. For example, the Fraser Institute’s most recent annual survey of physicians in Canada found that patients could expect to wait 20 weeks from GP referral to treatment for medically necessary treatments across 12 specialties (including orthopaedics, neurosurgery, urology and otolaryngology). This wait time was the longest ever measured in the survey’s history and was more than twice as long as the wait time in 1993 (9.3 weeks) when the first national estimate of wait times was produced.

Worse, when compared to other universal health-care systems around the world, Canada consistently ranks last or next to last on several important indicators of timely access to health care. For example, the U.S.-based Commonwealth Fund (in conjunction with CIHI) recently released the results of their survey of adults in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States—all countries with universal health-care systems (except, arguably, the U.S.). Canada ranked worst in terms of the ability to get a same or next-day appointment when sick, the wait for treatment in the emergency department, the wait to see a specialist and the overall wait for all elective surgery.

Yet in the face of this failure, patients in Canada have no recourse. Due to federal and provincial laws it’s extremely difficult for patients to escape these inordinately long wait times. Instead, they are often faced with the unhappy choice of waiting in pain while their situation deteriorates or the prospect of leaving their own country to access timely treatment.

Wait times have become the Canadian health-care system’s defining feature. This despite years of spending increases and continued promises from provincial and federal governments to do something about it. Nice headlines, from CIHI or elsewhere, pretending otherwise do Canadians a disservice. It’s time we all got honest about health care and started exploring policy options to improve our system.

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