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.

Evidence

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.

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.

Wait times in Canada are improving with 75 per cent or more of provinces meeting benchmarks for some procedures.

Needed: Better Data

Creating a single, common framework for reporting wait times is an effective first step, ie moving from individual wait lists for each physician to a ‘single list.’ This reduces inefficiencies which may arise if one provider is swamped, but another happens to have openings in his/her schedule, while still allowing patients to wait for the provider of their choice if the situation is not urgent.

Needed: Better Management

Appropriate management tools combined with getting the surgeons, primary care physicians and the health authorities working together, can have a significant impact on access to care. For example, a hip and knee pilot project in 3 Albertan cities reduced wait times for surgery from 290 to 37 days by altering the management model and at the same time brought hospital costs down by 15 per cent. Many projects have found the using tools from industrial engineering/operations research can greatly improve the efficiency of care delivery.

Cape Breton has taken a new approach to patient scheduling which seems to work. Traditional patient scheduling approaches can cause long wait times. “Advanced access” is an innovative, patient-centered approach to scheduling that leaves a physician’s appointment calendar relatively open and allows doctors to see more patients in a timely way.

The evidence suggests that Emergency room overcrowding is a complex problem to solve. Simply reducing the number of people coming through the ER door and introducing more primary care physicians will not resolve the backlog. ER overcrowding also requires better management of hospital beds. The solutions to ER wait times often are found elsewhere (e.g., by ensuring that primary care practices offer after-hours care).

Would a parallel private system help reduce waiting times in the public system? Research evidence suggests parallel private systems appear to lengthen waits for healthcare in the public system.

Needed: Agreement On – Is the Care Appropriate? What Is A Reasonable Wait Time?

In the management of waiting times for diagnostic tests and surgery it is necessary to develop standards for when treatment is appropriate and necessary and when it is not. Tools are available to help deal with this issue and with the prioritization of patients when a decision for testing or surgery has been reached, but they are not yet widely used in practice.

Sometimes, as with diagnostic imaging (CT and MRI scans) in Ontario, increased resources have led to a great increase in the number of procedures, with what may be relatively little patient benefit.

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 the United Kingdom fell dramatically in recent years. Why? There was an aggressive public policy push and unprecedented increases in public funding under the Blair government.

Over this period (1998-2008) the privately-funded share of elective surgery in the UK shrank from just under 15% to just under 11% according to Laing and Buisson, a firm which monitors these trends.

The Brits also introduced operational efficiencies through a ‘choose and book’ system

Wait Times In Canada

Ontario Stroke Evaluation Report 2012: Prescribing system solutions to improve stroke outcomes.
From CIHI: The Canadian Hospital Reporting Project (CHRP): is a national quality improvement initiative from the Canadian Institute for Health Information (CIHI). CHRP’s web-based, interactive tool gives hospital decision-makers, policy-makers and Canadians access to indicator results for more than 600 facilities from every province and territory in Canada.
Wait Times in Canada – A Summary, 2012
Note: CIHI data are updated on a regular basis. For the latest available information please visit their website (www.cihi.ca) or contact their media team at media@cihi.ca
Recommended Reading On Wait Times From The Health Council of Canada

Our Commentaries

How the federal government plans to end homelessness
By Vicky Stergiopoulos and Sam Tsemberis
Something largely overlooked by wide media coverage of the federal government’s Economic Action Plan 2013 was that it marked a significant change in the way we will tackle homelessness in this country.
What’s wrong with hospital rankings?
By Michel Grignon
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.
Keeping doctors where we need them
By Maria Mathews
How do we get more doctors to practice in rural communities? This has been a long standing challenge in Canada — getting physicians to work where we need them — especially in provinces with large rural populations.
Premiers’ priority should be home and community care
By Kimberlyn McGrail and Linda Silas
Provincial premiers will be meeting as the Council of the Federation at the end of July in Halifax and health care is almost certain to be on the agenda. The first report from the First Ministers’ Health Care Innovation Working Group will be presented at the meeting, and was promised to address health human resource and service delivery issues with a national lens.

Browse All Commentaries View French Commentaries

Comments are closed.