Reality Check

Surgical wait times: how much progress have we really made?

Thu, 28 Apr 2011 19:59:19 -0500

It was a central feature of the 2004 health accord, promoted by Paul Martin's Liberals and adopted by Stephen Harper's Conservatives as part of their 2006 election platform. And there seems to be general consensus that progress has been made.


We're talking about establishing and meeting the so-called bench marks for how long patients must wait for certain common elective procedures.


On the surface the statistics look impressive. According to the latest report from the Canadian Institute for Health Information, 80 per cent of Canadians waiting for surgery in four priority areas - cancer, heart, hip and knee replacements, and cataracts - are getting into the operating room within the time frames established by the first ministers in 2005.


"We would view wait times as one of the success stories of the current health accord," says John Abbott, chief executive officer of the Health Council of Canada, a group that monitors wait times.


"Bench marks and targets were set. Governments have been achieving those, for the most part."


But while he acknowledges the validity of that 80 per cent figure, Tom Noseworthy, a physician and professor of health policy and management at the University of Calgary, has a different take.


It means, he says, that there are still "a lot of Canadians, at least one in five, who are languishing beyond waiting-time targets."


More importantly, the 80 per cent figure doesn't tell the whole story.


Selective procedures


Under the definition used by governments and the Health Council, a wait time is the period between the moment the surgeon makes the appointment to the day of the surgery. But this definition is limited.


As CIHI puts it, "Before a decision is made, patients may wait to see a family doctor, to see a specialist, for tests and finally, for a diagnosis.


"Following the surgery, they may wait for follow-up treatment or services to assist with recovery. To affect meaningful change, understanding all waits across the continuum is necessary."


CIHI also notes that the surgeries on which its report is based only cover about one-eighth of the procedures performed in Canada and some of these can be fairly selective.


"For heart, it is coronary artery bypass," says Lorne Bellan, co-chair of the Wait Times Alliance, a physicians' group that issues its own yearly report card.


But as Bellan points out, when the health accord was announced, cardiac surgeons and cardiologists asked why pick coronary bypass surgeries as the target, because wait times for these were already on the decline.


"In heart care, the bottleneck is in things like stents, pacemakers and valve replacements.


"The cardiac group tried to lobby to get the bench mark changed to these other problem areas, but that was never done." This is one of the key reasons, Bellan says, why coronary surgeries receive such high marks.


The current numbers


With these caveats in mind, the CIHI numbers from its 2011 report read as follows:

  • 26 weeks for a planned hip replacement;
  • 26 weeks for a planned knee replacement;
  • 16 weeks for cataract surgery;
  • 26 weeks for coronary artery bypass graft surgery;
  • four weeks for radiation therapy.


Diagnostic tests such as CT and MRI scans were supposed to be the fifth area to be tracked, but the provinces and territories have yet to agree on benchmarks for these.


Remember, these wait-time bench marks are for elective surgery - emergencies go to the front of the line. They are also national averages.


The wait times for the procedures CIHI measures sound impressive, but they vary from province to province.


This means that, in some jurisdictions, people may wait substantially longer than 26 weeks for a knee replacement.


What are the parties saying?


Not much. The Conservatives, Liberals and the NDP are promising to maintain the six per cent increase in health transfers after 2014. So far, no one is talking about extra money to tackle wait times by either broadening the definition or expanding the number of surgeries that are tracked and measured.


The main parties have also said nothing about accountability; that is, about what to do with those jurisdictions that fail to meet their promises. What recourse does someone have if she waits more than a year to have her cataracts removed?


In their platform, the Conservatives have also pledged to respect "asymmetrical federalism" when renewing the health accord, an apparent reference to Quebec.


But critics like Bellan and Noseworthy suggest that is code for letting the provinces take the money without being fully accountable for how it will be spent.


They also argue that the 2004 health accord failed to set much of a precedent when it came to wait times.


In addition to the fact that the procedures only cover about one-eighth of all surgeries, the accord captures but a small portion on that wait-time continuum.


And while there has been progress in the procedures specified by the agreement, Noseworthy is concerned that even these wait times might begin to creep back up again because the extra money the federal government provided to deal with the problem has now dried up.

David McKie can be reached at

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