Doctors' group reports 'spotty progress' in easing patient wait times

Wait times improved slightly in five priority areas last year, but the time it takes patients to actually receive care remains shrouded in mystery, a coalition of medical experts said Thursday.

The fourth annual report card by the Wait Time Alliance, titled Unfinished Business, found only "spotty progress" has been made in reducing wait times in the five areas that the federal government and the provinces and territories agreed to under a $5.5 billion deal in 2004 — hip and knee replacements, cataract surgery, radiation oncology, cardiovascular surgery and diagnostic imaging like MRIs. 

'In many parts of Canada patients still cannot find out how long they can expect to wait for critical medical treatments and procedures.' — Dr. Lorne Bellan

The report praised Ontario, Manitoba and British Columbia for strong performances in improving wait times through "organized and concerted effort," while Atlantic Canada continues to lag behind in treating patients within maximum acceptable wait times.

Newfoundland and Labrador still does not have a web page dedicated to reporting on wait times, the report said.

"People can go online and track the progress of a package they shipped from one end of the country to another, yet in many parts of Canada patients still cannot find out how long they can expect to wait for critical medical treatments and procedures," WTA co-chair Dr. Lorne Bellan said in a release.

"We need to do a better job of tracking and reporting on the full wait that patients experience to access necessary medical care."

The priority areas of governments are benchmarks for maximum acceptable waits, rather than desired targets, the group noted.

Start wait time clock earlier

Based on CMA president Dr. Robert Ouellet's recent fact-finding mission to Europe, the alliance looked to the example of the National Health Service in England —  the country that seemed the closest to the Canadian health-care model.

The NHS set the maximum allowable target time for referral by a family doctor to day of treatment at 18 weeks, but many medical specialties in Canada don't come close to that, according to the report.

In March, British physician Dr. Matthew Cooke told doctors in Alberta that NHS spent roughly $1 billion to create thousands of beds in nursing homes so sick and elderly patients could be moved out of hospitals. Critics have questioned the cost of the British reforms.

In Canada, governments' benchmarks do not start the wait time clock from the time a patient is referred for specialist care to the time they actually receive treatment, an area the alliance tried to measure, Ouellet said in a speech in French to the Montreal Economic Institute on Thursday.

For example, 60 per cent of patients seeking a screening colonoscopy waited longer than 18 weeks for the procedure. The same waits were seen in 83 per cent of patients needing total knee arthroplasty or replacements.

The benchmark for waiting at an emergency department was set at six hours in 95 per cent of the most urgent cases. The median wait time for patients to be seen and discharged was almost six hours and the average wait was nearly nine hours.

And the average time for admission was 23 hours, often because of the inability to find an available hospital bed, according to the report.

European solutions

Ouellet listed solutions from Europe that Canada could draw on. For example, about six years ago, England started funding hospitals based on the number and type of patients they see instead of lump funding. The result was waiting times "melted like snow in the sun," he said.

In Denmark, patients waiting more than a month are automatically referred to private clinics, said Ouellet, a radiologist by training who owns and operates medical imaging clinics in Quebec. 

Likewise in France, wait times are kept in check by referring 60 per cent of non-urgent surgeries to private clinics. The surgeries are paid for under the public system.

Ouellet stressed he's not pushing for U.S.-style private medicine, which he called a poor performer in terms of life expectancy, infant mortality and spending per capita. About 46 million Americans under the age of 65 lack health insurance.

Include more specialities

The results were based on a Ipsos-Reid poll of 1,189 specialists who were surveyed in February on their views of wait times, and wait time data on 2,010 patients.

In a teleconference with reporters, Bellan said governments have failed to apply wait time targets to more clinical services as the alliance has previously urged, given research on how much governments lose in revenue when people wait for care.

The alliance, a partnership of 13 medical groups including the Canadian Medical Association, says governments must now expand their focus to establish wait-time benchmarks for other specialty procedures, specifically:

• Psychiatry.
• Obstetrics/gynecology.
• Gastroenterology.
• Plastic surgery.
• Anesthesiology.
• Emergency care.

"It would be much more efficient for the country if everyone was healthy and was productive and so I think that it would be money very well spent," to expand the targets, he said.