The patience of Canadian patients is wearing thin
A new survey by Angus Reid suggests the patience Canadians are famous for may be wearing thin—at least when it comes to wait times for medical treatment.
The survey collected responses from 1,500 Canadians who received orthopaedic surgery within the last 10 years and found that 22 per cent reported the time spent waiting for treatment was unreasonable. More generally, almost 30 per cent reported being dissatisfied with the amount of time they waited for surgery.
This should come as no surprise to anyone familiar with the long wait times that have become a hallmark of the Canadian health-care experience. The Angus Reid survey revealed that almost 30 per cent of the patients who said their wait times were unreasonable reported waits of between seven and 12 months for surgery, with a further 51 per cent reporting a wait of more than a year.
While governments across Canada may not consider the overall delay for orthopaedic surgery for most patients to be too unreasonable—their own pan-Canadian benchmark wait time (the target they wish to achieve for all patients) is a remarkably lengthy six months for joint replacement—physicians seem to agree that Canadians wait too long for such treatment.
For example, data from the Fraser Institute’s annual survey of wait times last year reveal that physicians consider a 12.2 week wait (weighted median, specialist to treatment) to be clinically reasonable for joint replacement. That is a far cry from the 26.3 weeks surveyed physicians said their patients could actually expect to wait for such treatment (after seeing a specialist) in 2016.
The kicker, however, is that the data regarding how long patients had to wait, and what they consider to be reasonable, and indeed what governments have determined is acceptable, is only measured using a particular segment of the total delay patients actually experience. It’s too often forgotten in these discussions that patients may (and do) face considerably long wait times just to see a specialist in the first place. In fact, physicians surveyed by the Fraser Institute reported that patients could expect to wait 15.6 weeks for a consultation with an orthopaedic surgeon (after getting a referral from their GP). There are also delays for the diagnostic imaging often necessary to come to a decision about treatment, not to mention delays accessing primary care providers for the necessary referral to specialist care.
While the wait times for orthopaedic surgery are certainly among the longest in Canada, patients in need of other types of elective treatments also face considerable wait times. For example, the total wait (referral to treatment) for neurosurgery was 46.9 weeks, ophthalmology was 28.5 weeks, and general surgery was 12.1 weeks in 2016. Averaged across 12 specialties, the total wait in 2016 was estimated to be 20 weeks between referral to treatment—115 per cent longer than the 9.3 weeks patients could expect to wait in 1993 (the Fraser Institute’s first national estimate of wait times).
Other surveys confirm Canada’s poor performance on wait times. For example, the Commonwealth Fund’s recent survey revealed that in comparison to 10 other countries (including Switzerland, Germany and the Netherlands), Canada ranked last in 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 elective surgery.
Some may take solace in the fact that the Commonwealth Fund’s report also suggested that Canada’s wait for hip and knee replacement was actually slightly shorter than the calculated average (based on data from the OECD and the CIHI). Unfortunately, that particular comparison was only in relation to Australia, New Zealand, Norway and the United Kingdom. Countries that were top performers in terms of the overall wait for elective surgery (Germany, France, the United States, the Netherlands and Switzerland) were all excluded from the hip/knee replacement analysis in which Canada seems to perform better.
Regardless, it’s notable that all the countries (except, some may argue, the U.S.) included in the survey (and that generally performed better on the majority of wait times indicators) also share Canada’s goal of universal health care. However, they generally allow private insurance and delivery of core medical services, expect patients to share in the cost of treatment, and remunerate hospitals on the basis of activity—policy options that generally contrast with Canada’s chosen framework.
Clearly, there are better ways to do universal health care, and we owe it to patients to implement those policies that will help deliver more timely care for similar cost—or at least allow them the option to seek alternatives without having to leave the country.
The Angus Reid survey corroborates a trend that the Fraser Institute has observed and reported on since the early ’90s. The evidence of the problem has long since been established. It’s now time for solutions.