How long should wait times be for most medical procedures? The answers are surprisingly elusive.
In this election campaign, wait times for surgery and other medical treatments are once again Canada’s hottest health-care issue.
In Ontario in 2003, Dalton McGuinty’s Liberals won power partly by promising to shorten wait times. The next year, Paul Martin did the same en route to the Prime Minister’s Office. Now, Conservatives charge that wait times have doubled under the Liberals.
Using wait times to measure medicare is a powerful idea: Vancouver’s conservative Fraser Institute helped create it with a national survey of hospital waiting lists held annually since 1990, which indicated that wait times lengthened dramatically after 1993. It’s a shorthand means of analyzing complex, under-audited provincial health systems.
But how long should wait times be for most procedures? The answers are surprisingly elusive.
In September of last year, Ottawa and the provinces announced a $41-billion, 10-year plan to patch up medicare, whose centrepiece was a $4.5-billion wait-times-reduction fund. The health ministers promised to develop scientifically sound national benchmarks telling patients how quickly they should receive five different kinds of treatment – diagnostic services, cancer care, cardiac care, joint replacement and cataract surgery.
The first set of benchmarks was to be issued by the end of 2005, a step many observers expected would lead to each province issuing wait-time guarantees. Voters could applaud: The idea of using wait times to measure the system as a whole had mushroomed into the notion of letting each individual measure it, by comparing services against scientific guidelines.
But then, after a summit in October, the health ministers seemed to backtrack. Developing anything like a comprehensive set of benchmarks was going to take a while, they said. George Abbott of British Columbia suggested the wait for wait-times benchmarks could be as long as five years.
Physicians’ and patients’ lobby groups were irate. “We take issue with the ministers’ argument there’s not enough evidence available to table wait-time benchmarks for numerous specific treatments right now,” said the president of the Canadian Medical Association, Ruth Collins-Nakai. “It worries me that they continue to weasel out of it.”
But in the background was a research dilemma. The provincial and territorial health ministries had commissioned the Canadian Institute for Health Research in Ottawa to analyze the issue, and what the CIHR discovered was not encouraging: Only one of its eight research teams found even a marginal amount of data on which benchmarks could be based.
One researcher, Marcy Winget, with the Alberta Cancer Board, combed through 1,000 studies concerning wait times for colorectal and lung-cancer treatment before reporting most of them “were poorly conducted.” At the University of Calgary, researcher Thomas Noseworthy found much the same thing after reviewing scientific studies of wait times for eye surgery and joint-replacement surgery.
The CIHR researchers aren’t the only ones worried about the soundness of the politically attractive idea of benchmarks. “There is a science gap,” admitted Brian Postl, the prime minister’s personal adviser on the matter.
Dr. Postl suggested that provincial and federal officials might have to take a “best guess” approach – making common-sense determinations based on “a blend of resource availability and patient appropriateness.”
Although that’s quite different than what the ministers promised, it’s an idea strongly endorsed by Stephen Lewis, a Saskatoon-based consultant who specializes in helping health ministries shorten waiting times. Mr. Lewis said he worries that a search for science-based benchmarks would be lengthy and possibly fruitless. “I think it may even be a stalling tactic,” he said.
He suggested Canadian health ministers instead mimic Britain’s Labour government, which simply committed to shorten wait times for all treatments to a maximum of six months by the end of 2005, and 18 weeks by the end of 2008.
In London, John Appleby, chief economist for the King’s Fund, which conducts policy research for Britain’s National Health Service, said the Labour government’s effort has worked well so far.
“There simply was the feeling that no one should wait, say, 12 months for hip replacement,” Mr. Appleby said. “The waiting times are very good now. For cataract surgery the majority of cases are done in three months, down from 12 to 15 months. There’s a fast-track cancer procedure with two weeks as the treatment target.”
There’s nothing scientific about that figure, he said. It just seemed like a humane one.
Paul Webster is a medical writer based in Toronto.
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