Canadians don’t have to pay a lot more to get better access to care

Public opinion polls tell us that Canadians’ big concerns with the healthcare system are waiting times and access to care.  While sometimes more resources (e.g., more staff) reduce wait times, evidence suggests that many issues contribute to wait times and several approaches exist for solving them. For instance, accurately recording wait times is an important first step in reducing wait times, while ensuring appropriateness of care (is this MRI necessary?) is another.  Further, many long wait times are due to a failure to use appropriate management tools rather than insufficient resources.  Work that has been done changing management practices in Alberta and Ontario has rapidly reduced wait times without increased resources. Sometimes of course, more resources do help.  In addition, all waits are not equal – in Canada, studies demonstrate that people generally have rapid access to emergency and essential care.

The Saskatoon Community Clinic implemented its Advanced Access model of booking patients with its family doctors and nurse practitioners in 2004. Now most patients are seen the day they want to be seen and many are seen the same day. The community clinic has assisted the Saskatchewan Health Quality Council attempt to implement advanced access throughout the province.

We could also eliminate most delays for specialty care. In Hamilton, the Mental Health and Nutrition Program integrates the practices of over 100 family doctors, with 17 psychiatrists, 80 counselors (most of whom are social workers), and 20 dietitians.  In the mental health component, the counselors are based with family doctors.[i]^,[ii] As a result of the program, 1100 per cent more patients have been seen with mental health problems in primary health care while referrals to the psychiatry specialty clinic have simultaneously dropped by 70 per cent. All patients are given standardized assessments and the program has documented improvements in depression scores as well as general health and functioning.

We can even decrease wait times for elective surgery. 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 Alberta Bone and Joint Health Demonstration project used a variety of different processes to reduce waiting times.[iii] In the regions where this program operated:

• Wait times from first referral from family doctor to first visit with orthopedic surgeon dropped 80 per cent, from 35 weeks to six weeks.
• Wait times from first visit with orthopedic surgeon to surgery plummeted 90 per cent, from 47 weeks to 4.7 weeks
• Length of stay in hospital fell 30 per cent, from six days to four days
• Patients surveyed expressed increased satisfaction.

In the management of waiting times for surgical services, it is also necessary to consider the different thresholds for surgery that exist among and between surgeons. Tools are available to help deal with this issue and with the priorization of patients when a decision for surgery has been reached, but they are not yet widely used in practice.

[i] Kates N, A-M Crustolo, S Farrar, et al., Mental health and nutrition: integrating specialists’ services into primary care, Canadian Family Physician, 2002;48:1898–1903.
[ii] Kates N. Managing chronic mental health problems in primary care. Presentation to Ministry of Health and Long-Term Care Expo. April 19, 2006. Toronto.
[iii] Alberta hip and knee replacement project: Interim results. Alberta Bone and Joint Institute. December 2005. Found at:   http://www.albertaboneandjoint.com/PDFs/Int_Rep_Dec_19_05.pdf.  Accessed December 20, 2005.