The Canadian wait times reduction strategy was launched at the First Ministers’ Meeting on the Future of Health Care in 2004, and seeded by a $4.5-billion commitment by the federal government over six years. Two Ontario bodies, the Ontario Health Quality Council (OHQC) and The Canadian Wait Time Alliance, closely track wait times in the public system and publish their findings in annual reports. Since 2004 there have been impressive reductions in Ontario wait times for some procedures. During the same period, there has also been much study and performance monitoring, and key performance benchmarks have been established.
We are all used to waiting for care. But how long is too long, and how short a wait can we afford? Depending on the service, the answer to the first question is either a function of best medical practice or one of convenience. On the other hand, the answer to the affordability question is purely a function of financial resources, process efficiency and a little bit of queuing theory. To use an admittedly less clinically complex analogy, call centre operators deal with the cost/access trade-off every day, and they can calculate the costs of different service levels almost to the penny because they have algorithms that do the math for them.
Following the call centre analogy, if every caller’s call were answered on the first ring, the call centre’s compensation cost structure would feature top pricing acceptable only to customers requiring service on demand. (Think of 911 service.) Add to the cost formula a compensation premium for the most customer-friendly and competent call agents, and voilà, the challenge of managing wait times in a private/public health system becomes a little clearer. Two-tier health care contributes to the creation of a two-tiered employment market as well, and it can have cannibalizing effects.
Whenever people have a health need, waiting is a fact of life, whether the wait time is measured from the point they present themselves at emergency, call the doctor for an appointment, or have surgery scheduled. The only objective way to determine how we are doing at reducing wait times is to compare our performance with established benchmarks and with the same indicators in other countries.
Let’s take one of each: an Ontario benchmark and an international comparison. For the latter, let’s illustrate with a case to which we can all relate, which is the time taken to see our doctor when we call for an appointment. How does Ontario perform? According to the 2008 Commonwealth Fund International Health Policy Survey of Sicker Adults (sicker adults being respondents who assessed themselves to be in fair or poor health according to criteria provided to them), 38% of sicker adult respondents in Ontario reported that they were able to see their doctor the same day they called for an appointment, compared to 43% in the U.S. and 79% in the Netherlands.
Let’s also look at wait times for time-sensitive surgeries, such as for cancer, and particularly cancer surgeries considered urgent. According to the Ontario Health Quality Council’s 2009 report, 90% of such cancer surgeries were performed within 52 days in December 2008, down from 81 days in September 2005. This is a major improvement, yet only half the urgent care patients were having their surgeries within the two-week clinical benchmark. The report’s authors admit that more work has to be done to reduce wait times for certain cancer surgeries.
On the Wait Time Alliance’s “A” list are hip, knee and cataract surgeries, wait times for which have come down dramatically since 2005. Time will tell if momentum can be maintained, particularly in light of the growth in private pay services.