You know things are bad when the best you can say is “at least it hasn’t gotten any worse.” That, essentially, is the main takeaway from the Canadian Institute for Health Information’s updated report on wait times for healthcare in Canada.
The media seems to have taken the bait, though, seemingly content with CIHI’s news release titled “Wait times remain stable, while number of procedures grows” and an infographic showing that “[a]bout four out of five Canadians have their procedure done within medically acceptable wait times.” In fact, the same release could (and probably should) be titled “Wait times have not improved” while the infographic could focus instead on the roughly one out of five Canadians who do not have their procedure done within medically acceptable wait times.
To be fair, the CIHI does an important job of collecting healthcare data in Canada. However, when examining the annual wait time statistics in their recent report, one should be cognizant of three important details.
First, the report is not comprehensive. The overarching conclusions are primarily based on five procedures for which pan-Canadian benchmarks were established in 2004 – hip replacement, knee replacement, hip fracture repair, cataract surgery, and radiation therapy. While some other procedures and diagnostic tests (in certain provinces) are mentioned, the report ignores almost 90 per cent of surgical procedures performed in Canada.
Second, the “acceptable” wait times benchmarks used in the study are remarkably long. For example, the benchmark for hip and knee replacement is about half a year, while the benchmark for cataract surgery is 16 weeks. While these benchmarks might have been deemed “reasonable” by those who established them in 2004, it’s questionable whether they are reasonable for patients who are forced to endure these long wait times.
Third, the wait time measures are incomplete. Provinces usually only measure a portion of the wait time journey (i.e. the time between consultation with a specialist, or booking a service at a hospital, and receipt of treatment). What’s entirely ignored is the long wait that patients have to face before they even get to see a specialist and decide on treatment.
In reality, the actual delays patients experience in Canada are considerably longer than what the CIHI and governments routinely report. For example, according to the Fraser Institute’s most recent annual wait times report, the median wait time to see an orthopedic specialist in Canada was 18.9 weeks in 2014 – after which patients could expect to wait a median 12 to 65 weeks (depending on the province) for joint replacement.
Like the CIHI’s report, the Fraser Institute study also finds (across 12 major medical specialties and 10 provinces) that wait times have somewhat stabilized over the last five years. However, they have done so at an historical high of about 18.2 weeks – almost twice as long as it was in 1993 (9.3 weeks).
Importantly, the physicians surveyed routinely indicate that their patients are waiting about three weeks longer than what they consider to be “clinically reasonable” – never mind what patients may consider reasonable. These excessive delays are not benign inconveniences and can have real consequences. Pain, suffering, lost income, poorer medical outcomes, or even death.
Finally, the CIHI’s claim that wait times for at least three surgical procedures (for which data were available) are better than the handful of countries cited in the report is misleading at best. None of these countries is known for excellence in avoiding delay. In fact, data from the Commonwealth Fund repeatedly indicates that Canada fares worse than other countries with universal healthcare systems when it comes to wait times for specialist appointments and treatment.
Rather than being content with the fact that wait times have not worsened considerably over the past five years, we should instead focus on why wait times have almost doubled over the past two decades, and seek out better ways to eliminate unnecessary (and harmful) delay.
Bacchus Barua is a senior economist in the Fraser Institute’s Centre for Health Policy Studies.