National wait-time grades haven't improved for medical treatments that federal and provincial governments agreed to provide more quickly, according to a new report card.

The Wait Times Alliance, which includes doctors from specialties such as emergency medicine, radiology and cardiology, released its annual report on wait times, titled "Canadians still waiting too long for health care," on Tuesday.

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Emergency room waits could be eased in part by addressing the needs of people in hospital beds who are waiting to be transferred to a long-term-care facility or back home. (Alex Brandon/Associated Press)

"Tackling the long waits for care in this country requires not just a tune-up but a major overhaul in health care," the group's chair, Dr. Chris Simpson, told reporters from Ottawa.

"Nationally, not only has there been no progress over the last year in wait times in all five priority areas, in fact, Canadians in many instances are waiting longer now than they were two years ago."

The report pointed to continued backsliding on the percentage of patients treated within government-approved benchmarks for wait times, which the group called the minimum acceptable time.

"We've seen in an increase in the number of surguries, but the demand has outstripped the number of procedures that are being done," said Simpson. "We've managed to tread water."

For example, the group's 2012 report card showed it often takes longer for patients to see a specialist than it does for them to start treatment.

Most provinces are trying to address wait times, but Simpson said "structural changes" are needed because "the money didn't buy change."

The group suggested:

  • Addressing the needs of patients who are elderly and those needing "alternate level of care" — the 14 per cent of people in hospital beds who are waiting to be transferred to a long-term-care facility or back home with support services.
  • Reorganizing how hospitals are funded, as British Columbia and Ontario are starting to, so money follows the patient and hospitals are offered an incentive to provide more services efficiently. The Netherlands used this model to actively search for hospitals with shorter wait times on behalf of patients.
  • Developing patient-centred models of care from the ground up.

"In other jurisdictions, particularly in Europe, where information is available and patients are given a bit more of choice or at the very least they're given information on how long they have to wait, given information on outcomes, then they can act a little bit like consumers and distribute the demand a little bit differently," Simpson said. 

Simpson pointed to individual success stories in pilot projects.

Orthopedic wait questions

"But without a sort of national sensibility, we aren't able to translate that into something we can truly say is a Canadian improvement in a Canadian health-care system."

Last week for example, researchers at Toronto's Institute for Clinical Evaluative Sciences reported that four of five patients in Ontario did not receive surgery within 18 months of visiting an orthopedic surgeon, who are trained to perform hip and knee replacements.

Of the 477,945 patients, 49 per cent visited orthopedic surgeons for injury, and 24 per cent for arthritis, Elizabeth Badley, an adjunct scientist at ICES and her co-authors said in the journal PLoS One.

It's the first time this has been looked at in detail anywhere in the world, Badley said.

"Does this high volume of non-surgical patients increase waiting times for a first appointment with an orthopedic surgeon and therefore get in the way of individuals who are in urgent need of surgical  care? That we don't know."

The findings also raise questions about whether all of the patients need a surgeon's special skills. Perhaps some patients with joint and bone concerns could be seen by other health-care professionals such as sports medicine doctors, primary care physicians with an interest in musculoskeletal conditions, physiotherapists or chiropractors, Badley suggested.

"We need a comprehensive strategy to deal with the aging population," she said.

The alliance also called for Canada to adopt a national strategy on dementia that focuses on keeping elderly people out of hospital. 

Access to primary care also continues to be an issue, particularly for individuals from low-income neighbourhoods who are more likely to report difficulties making appointments with their family doctor.

The alliance said it established wait-time benchmarks for 925 treatments, procedures and diagnoses that have the highest volumes, greatest potential for improvements or greatest potential return on investment.

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With files from CBC's Kelly Crowe and Amina Zafar