The 2014 Commonwealth Fund Survey, which ranked Canada last in timeliness of care, was one of many studies highlighting Canada’s dismal record on health-care wait times. As wait times increased in the 1990s and evidence mounted about their adverse effects on patients, provincial governments were slow to respond, in part because the health-care system was dominated by providers rather than focusing on patients and the timeliness of care.
Pressure to address wait times came from the Supreme Court’s 2005 decision in the Chaoulli case, which focused on patients and their right to timely treatment and the need for governments to tackle the wait time problem. And pressure also came from patient accounts of suffering while waiting for treatment and the Fraser Institute’s annual survey of physicians across Canada, which highlighted how actual wait times (specialist to treatment) for elective surgeries in various provinces were longer than what physicians considered clinically reasonable.
The Fraser Institute’s annual study also showed that Saskatchewan had some of the longest wait times in the country in the late 1990s and throughout the 2000s. In 2010 the Saskatchewan government made the bold promise that by 2014 no patient would wait more than three months for elective surgery as part of its wait time reduction strategy, the Saskatchewan Surgical Initiative (SSI). In developing the SSI, Saskatchewan worked with and learned from other provinces, belying the image of a fragmented health-care system where leadership must come from the federal government, and built upon previous Saskatchewan initiatives to reduce waiting lists.
The SSI changed the way waiting lists were managed: waiting lists were centralized, patients prioritized and referrals pooled so that patients could use the Internet to choose their physician armed with the knowledge about the length of their wait for treatment.
The SSI also fundamentally changed the culture and decision-making process in health care. The 2015 Health Canada report on health-care innovation cited three factors that drive innovation and all were central to the SSI.
One was leadership, provided by the bold target set by the government. Another was an inclusive collaborative decision-making process that helped gain the support of key stakeholders. The third was a patient-centered focus, which involved including patients in decision-making and better integrating the system so that patients could be moved through it in record time.
Effective communications also help explain the success of the SSI, especially the selling of its most controversial policy: the use of private for-profit clinics to deliver day-surgery procedures covered by Medicare. The government countered vocal critics of the clinics by being transparent about the selection process for the companies that would run the clinics and the standards that they had to meet. Also, government communications focused on the patients and their right to timely care rather than on the significant savings achieved by moving procedures from hospitals to clinics. Most important, however, was the message that the clinics would reduce wait times. After years of living with long waits for treatment, Saskatchewan people were prepared to set aside ideology and judge the clinics on their results.
In March 2014 the government declared victory when it announced a 75 per cent reduction since 2010 in patients waiting more than three months for surgery. In 2015 the Fraser Institute survey showed that Saskatchewan had the shortest waiting lists (GP referral to treatment) for elective surgery in Canada.
Though the SSI dramatically reduced wait times for elective surgery, long waits remain in other areas and capacity had to be increased, which meant more money for an already expensive health-care system.
Also, the SSI did not tackle what international studies cite as a major cause of Canada’s long waiting lists: the structure and funding of Medicare. Thus, the SSI treated the symptom – the waiting lists – rather than the root problem – Medicare’s structure and funding.
But the SSI was not designed to fix Medicare. Its goal was to relieve the suffering of patients who were waiting far too long for surgery. In that, it succeeded.
Dr. Janice MacKinnon is a former Saskatchewan NDP finance minister and current professor of fiscal policy at the University of Saskatchewan School of Public Health.
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