Waiting for care
Waiting for Care
What’s the Issue?
Public opinion polls tell us that Canadians’ big concerns with the healthcare system are waiting times and access to care. But how bad are wait times really? And what will it cost to improve the situation? The following three points will help shape the issue:
First of all, not all waits are or should be equal. For example, studies demonstrate that Canadians generally have rapid access to emergency and essential care. Whereas, wait times for joint replacement could use improvement.
Second, many issues contribute to wait times. This is good news because it means that improving wait times is not just about pouring money into the system. Many long wait times are due to a failure to use appropriate management tools, rather than insufficient resources. For instance, moving from every surgeon their own “list” to a single organized list across surgeons is an important first step in reducing wait times. Ensuring appropriateness of care (e.g. is this MRI necessary?) and priorizing patients according to their relative urgency is another.
Third, several approaches exist for minimizing wait times. Some of these strategies are already working successfully across Canada. For example, the Ontario Wait Times Strategy has been particularly effective. It has demonstrated significant reductions in wait times for joint replacements, cataract surgery, and other elective procedures.
- The Health Council of Canada has completed a six-part pan-Canadian video series, “Innovations in Reducing Wait Times”, featuring innovative practices that are tackling waits for patients in various health care settings. To view these videos in English or French visit healthcouncilcanada.ca/waittimes.
- The Health Council of Canada features a video blog, “How queueing theory can influence wait time”, by Dr. David Stanford of Western University. In this video blog, Dr. Stanford demonstrates how queueing theory applies to wait times and how simple changes can have a big impact on reducing them. To view this video in English or French visit healthcouncilcanada.ca/waittimes.
- Progress Report 2013: Health care renewal in Canada from the Health Council of Canada. The report highlights progress achieved since 2003 in five key areas: wait times, primary health care and electronic health records, pharmaceuticals management, disease prevention/health promotion and Aboriginal health, since the 2003 and 2004 health accords were signed. The report finds that, overall, efforts at reform are not meeting the health care needs of Canadians. Across all areas, a consistent challenge is access to care, which continues to vary among and within jurisdictions across the country.
- See our infographic on 2011 wait times in Canada: Still waiting, by Lindsay Jolivet.
- 47% of physicians say most or almost all of their patients get same-day or next-day appointments. Also, 46% of physicians have made arrangements for their patients to see a physician or nurse (other than at the ER) when their practice is closed. The Health Council of Canada presents How do Canadian primary care physicians rate the health system?, a report that examines physicians’ perspectives on the performance of the health care system based on their experiences with access to care, coordination of care, use of information technology, and practice improvement and incentives. (See infographic).
- Wait time performance has slipped in the past year, the Wait Time Alliance, a consortium of 14 medical groups, says in its 2012 annual report. Although some provinces have shown improvement, the overall trend is downward, the WTA adds. The WTA has been measuring wait times for six years, and the five procedures First Ministers identified as priorities in the 2004 health accord. These are cancer (radiation therapy); heart (bypass surgery); joint replacement (hip and knee); sight restoration (cataract) and diagnostic imaging (CT and MRI scans). Benchmark wait times were subsequently set by health ministers.
Why do we wait?
- If Canadian physicians say that only 47% of their patients can get a same-day or next-day appointment when requested, health care leaders need to better understand the implications on patients around wait times and apply known solutions to these recurring problems. The Health Council of Canada has launched the first two videos in a multi-part series that will continue through the summer and Fall 2013, pointing to where exactly we’re seeing progress on wait times in our health care system and how examples like these can be adapted in new locations for the benefit of more Canadians.
- Visit http://healthcouncilcanada.ca/waittimes, to learn about wait time success stories in Thompson, Manitoba (Advanced Access for the Primary Health Setting) and St. John’s, Newfoundland and Labrador (Centralized Intake for Orthopedic Surgery). To access the Health Council’s Health Innovation Portal, where you can search further solutions to reducing wait times, please visit: www.healthcouncilcanada.ca/innovation.
Is Physician Shortage a Driver of Wait Times?
- Increases in physician supply slowed in the 1990′s and several provinces, particularly Ontario, experienced a decline. However, in most provinces, the declines have been reversed and the number of physicians has climbed steeply to the highest levels ever in the past several years. View a province by province graph on physician supply.
Needed: Better Data
Needed: Better Management
Needed: Agreement On – Is the Care Appropriate? What Is A Reasonable Wait Time?
Needed: More Resources (At Least Sometimes)
- While we have reviewed several aspects of improving wait times which don’t necessarily require more resources, sometimes more resources are indeed what is necessary.
International Efforts To Improve Wait Times
Wait Times In Canada
Report card on wait times in Canada omits important developments
Canadians might have been inclined to take a sedative for an anxiety attack after reading about the Wait Time Alliance’s (WTA) 2014 report card on waits for medical care in Canada. The WTA gives Canada a failing grade on the structural changes it says are needed to have the timely access to care seen in other countries.
When more beds aren’t enough
Alberta’s provincial health authority has recently come under fire by opposition party MLAs and activists alike for closing 77 Calgary long-term care beds damaged by the June floods. The angry reaction demonstrates the common misperception that a shortage of beds is the major cause of persistent waiting lists for long-term care.
What’s wrong with hospital rankings?
The CBC's Fifth Estate recently produced an investigation on the quality of hospitals in Canada – “Rate My Hospital” – which has been enormously popular and set off discussions across the country about the need to improve our hospital services.
Linking hospital quality to payment
For several decades, the amount of funding that Ontario’s hospitals receive each year has been based more or less on the funding they received the previous year, regardless of their patients or their performance.