Waiting for the Cure
By Robert Sheppard, CBC.ca Reality Check Team | Dec. 12, 2005 | More Reality Check
In September 2004, promising to "fix medicare for a generation," Prime Minister Paul Martin pledged $41.5 billion to the provinces over 10 years to hire more doctors and nurses, and find smarter ways to reduce the increasingly long waiting lists that were undermining Canadian support of the health-care system. As part of the deal, the two levels of government promised to come up with what they called "evidence-based benchmarks" in five key areas—cancer treatment, heart surgery, diagnostic imaging, joint replacements and cataract removals—by the end of 2005. This they did Monday, in the midst of the federal election campaign, adding fuel to the debate begun by Conservative Leader Stephen Harper at the outset of the contest when he pledged what he called a Patient Wait Times Guarantee.
What is being promised
The benchmarks propose radiation treatment for cancer victims within four weeks of being ready for treatment. That compares with the current wait of three to 6.5 weeks, depending on the province, according to the annual wait times report from the Fraser Institute in Vancouver.
Earlier in the campaign, Harper said he would like to see waits for radiation set at about 10 days, same as that proposed earlier this year by the Wait Times Alliance, a coalition of health-care groups led by the Canadian Medical Association.
For hip and knee replacements, the benchmarks say patients should be operated on within 26 weeks of being seen by a specialist. The current reality ranges from 16 to 54 weeks; the Wait Times Alliance suggests 24 weeks, while Harper has set 40 weeks as his limit.
For the others, where there are not the same comparisons, the benchmarks would have cataract removal done within 16 weeks for patients deemed at high risk; breast cancer screening for women 50 to 69 every two years and cervical cancer screening for women 18 to 69 every three; and cardiac bypass surgery within six weeks for those deemed at moderate risk.
What is missing
- Targets. The benchmarks are basically a best-efforts goal by the provinces to come up with long-range standards that they can implement beginning in 2007. They are not what health-care experts call targets—specific plans to treat a set number of patients within an allocated time. As well, the benchmarks tackle only those wait times that begin when a patient sees a specialist, not the GP, which is where many of the bottlenecks in the system occur.
- MRIs. The benchmarks are suspiciously silent on the whole area of diagnostic testing, one of the five clinical areas specifically set out in the 2004 federal-provincial deal. This is because some provinces, notably Ontario, are trying to limit the use of MRIs and PET scans for some kinds of services, questioning their validity. Some also wish to use private clinics to provide these services.
- Care guarantees. The benchmarks are simply goals of what medical science says patients should expect to wait for specific procedures. They are not legally enforceable guarantees. Only Harper has come close to making such a commitment. His Patient Wait Times Guarantee promises that if patients are not treated within an acceptable period in their own regions, they must be provided with the option to be treated in another hospital or even a private clinic outside their own province.
What the parties are saying
Harper said his proposals and patient guarantee would stay within the $41.5-billion budget established by the Liberals. He says he is not proposing two-tier medicine but also went out of his way to say he would not shut down the private clinics that are being increasingly used in some western provinces in particular to help alleviate wait times.
NDP Leader Jack Layton has not yet released a detailed health-care strategy but he reiterates at almost every campaign stop that no future federal funding should go to for-profit clinics. That's a position that could prove more politically explosive after Jan. 23, should he hold the balance of power.
Liberal Health Minister Ujjal Dosanjh, one of the key negotiators of the benchmark announcement, claimed it is a watershed moment in medicare history that will now give Canadians a clear idea of what to expect when waiting for specific procedures. However, given what the Supreme Court of Canada said earlier this year, in its landmark ruling on the Quebec system—that wait times are killing patients and the provinces better do something about them—merely having an idea of what to expect might not be enough.
For more information
At least seven provinces—B.C., Alberta, Manitoba, Saskatchewan, Ontario, Quebec and Nova Scotia—now have websites with their own wait time registries for specific procedures. These can be found through the Canada Health Agency site (PDF file).
The Canadian Medical Association is one of the key groups in the Wait Times Alliance.
A CBC in-depth report on health care.
The Vancouver-based Fraser Institute publishes a detailed report on wait times. Its most recent, a survey of 12 specialties and 10 provinces, found an average wait of just less than 17.7 weeks from GP to final procedure.
It notes that is almost double the wait from 1993, when the Liberals took power.