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IN THE NEWS: Health Care Wait Times – What is the Real Story?

Posted: December 8, 2015

(December 8, 2015)

By: Natalie Mehra, Executive Director, Ontario Health Coalition

Today, a high-profile report tracking health care wait times was released from the Wait Times Alliance. Eliminating Code Gridlock in Canada’s Health Care System, is a credible summary and a useful addition to public policy decisions about health care planning. It is written by an alliance of physician specialists’ organizations to track progress in wait times and public reporting.

Leeching off of the publicity for the day, the Fraser Institute — a pro-privatization think-tank (see Who Funds the Fraser Institute? here and here) — also released their annual wait times report. Releasing this report at the same time as the release of the Wait Times Alliance Report may garner extra media, but it is bound to cause confusion.

Both reports are about wait times in health care. But the similarities stop there.

The methodology of the Fraser Institute is based on the subjective viewpoints of the small proportion of physician specialists who answer their surveys. If you read the methodology section of their report, you will find that their response rate is only 21%. That is, they received answers from just one in five of the physicians they surveyed.The Fraser Institute uses a number of different methods to take these survey results and turn them into the median (middle) wait times that they report nationally and for each province. Different medians reported are based on different methods of calculation, all stemming from the original surveys gathering the perceptions of a small sample of physicians. Some of these methods require significant contortions indeed. In fact, there are a number of issues that one could raise regarding their methods. In the end, the Fraser Institute is a strident promoter of for-profit privatization of health care. Their report should be treated accordingly.

So, focusing on the report that is worth looking at —

The Wait Times Alliance report is a thought-provoking addition to the body of research on access to care and timeliness of care. The report shows that significant funding investments in the public hospital system including better wait list management and pooled referrals, additional operating room nurses and health professionals have improved wait times in Saskatchewan. The report also shows that Ontario has one of the most robust reporting systems in the country, not only reporting on wait times for an array of surgeries and diagnostics, but also long-term care and home care wait times, and data regarding Alternate Level of Care. Our government is leading the way in terms of improving transparency in reporting of wait times. Since last year, the provinces that have been doing well in specific types of wait times — MRIs, hip and knee surgery, cardiac surgery and cancer surgery — are continuing to do so. These provinces include Ontario, Saskatchewan and Alberta.

On the negative side, most provinces do not report their wait times on most procedures, so the report is based on limited information and only from those provinces that do report. Long waits in hospital emergency departments were cited in Ontario. Waits are up to 26 hours for Ontario patients with complex conditions that require additional diagnostic tests or admission into a hospital bed. Though the report does not say this, many of these waits are due to a severe shortage of hospital beds. (Ontario has cut more beds than anywhere in Canada.) The report did not look at wait times for home care and long-term care this time around. Nor did they draw many serious cross-country comparisons, other than the one looking primarily at the five target procedures set out in the 2004 Health Accord (MRI/CT, and surgeries for hips/knee, cardiac, cancer, cataracts).

The Wait Times Alliance advocates for improved reporting on wait times for seniors’ care and for those health services that are provided directly by the federal government including First Nations’ health care services, care for veterans, the armed forces, Corrections Canada, and refugees. These are good recommendations that we should support.

There is only really one item with which we would take issue in the report: there is considerable confusion about Alternate Level of Care (ALC) patients.The report notes that there is no common definition of ALC across the country. It uses Ontario ALC figures to suggest that 13.7 per cent of hospital beds are taken by ALC patients. But what it does not note is that many of those patients are in one type of hospital bed waiting for another type of hospital bed (not waiting for discharge to long-term care or home care). In fact, almost none are waiting for discharge for home care, as, unfortunately, most home care – ready patients are discharged and wait for home care at home.The misuse of ALC figures is rampant among health care’s “chattering classes”. Few have actually looked at the hospitals’ ALC surveys to see what the data really shows. Unfortunately, this misinformation is driving dangerous levels of hospital cuts. We will seek to meet with the Wait Times Alliance to discuss this. There is also a gratuitous positive mention of the LEAN methods in the report, without any real analysis. We receive endless complaints about this Toyota management system that is now being used in public hospitals.

The new federal government of Justin Trudeau promised to renegotiate a Health Accord with the provinces. The Wait Times Alliance is calling on the federal government to show leadership in addressing the issues raised in its report card and in continuing to push for improvements in wait times.

Today and in coming days, we will see these reports used, particularly by proponents of privatization to try to further dismantle public hospitals and facilitate the takeover of health care by for-profit companies. The most aggressive privateer of all at the moment, Saskatchewan Premier Brad Wahl, will likely try to contort the findings to push for more health care privatization. What the data actually show is that provinces that have a lot of privatization (see Quebec and B.C., for example) either do not report at all or do not measure up well at all in cross-country comparisons of wait times. Instead the evidence is that patients in those provinces are being charged fees ranging from hundreds to tens of thousands of dollars for medically-needed care. On top of these user fees, private clinics are billing the public system — for the same procedures. In fact the evidence shows that the improvements that we have seen in reducing wait times in Ontario, Saskatchewan and elsewhere have occurred when governments have improved public funding for public hospitals, increased trained nurses and health professionals, and better organized and managed wait lists. In this way, access to care is improved for all, and equity for all Canadians regardless of their personal wealth is preserved as the cornerstone value upon which our public health system rests.