Laggard to leader—how Saskatchewan shortened wait times
In 2008 Saskatchewan had the dubious distinction of being the province with the longest wait times for medically necessary treatment in Canada. While the national average wait for treatment after seeing a GP was an abysmal 17.3 weeks, the wait in Saskatchewan was almost 29 weeks.
However, in 2015, with a median wait time of 13.6 weeks, Saskatchewan ranked as the Canadian province with the shortest wait times for treatment.
How did this province, which trailed every other Canadian province as recently as 2008, manage to become a model for success?
The answer is simple. By doing things differently.
In 2010, the provincial government launched the Saskatchewan Surgical Initiative to tackle the growing wait times problem. While the program implemented policies based on several well-known themes—bold leadership, an inclusive collaborative decision-making process, and a patient-centred focus—two policies deserve to be highlighted in particular.
The first is the implementation of a pooled-patient referral system. As result of following a gatekeeper system, patients in Canada are required to get a referral from a general practitioner before they can see a specialist. While this is not unusual, it meant patient wait times were unnecessarily lengthened by not taking advantage of shorter waits for alternate doctors. Instead, by pooling referrals into a central registry, patients could now be referred to the next available qualified specialist. Importantly though, patients still retain the choice to wait longer for the specialist of their choice if they wish to do so.
The second, and certainly more controversial policy, was the contracting-out of select day surgeries (cataracts, ACL repair, and certain gynecological procedures, for example) to private clinics. By doing so, the province was able to expand total surgical capacity in a short period of time, while also freeing up resources in public hospitals for more complex treatments. The province dictated strict guidelines for the private clinics involved, such as abiding by the Canada Health Act, and ensuring that the cost of service was equal to, or less than, what was offered by public hospitals.
Remarkably, data indicates that on average the clinics were able to offer services to patients at costs that were 26 per cent lower (per procedure) than in comparable public hospitals.
Of course, while wait times in the province have certainly decreased there is still considerable room for improvement. Wait times in Canada are generally among the longest in the developed world in spite of our relatively high level of health expenditures. As well, there remains a concern about the overall financial sustainability of the system.
While true reform addressing the flawed structure and funding of Medicare remains elusive, other provinces should—in the meantime—consider the sort of policies that have enabled Saskatchewan to improve (although not eliminate) wait times for medically necessary treatment within our current health care framework.
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