A 2017 report by the Canadian Institute for Health Information (CIHI) that examined patient wait times for five priority medical procedures in 2016 determined that medical wait times have nearly doubled in Canada in the last 20 years. CIHI is a non-profit group with a mandate to collect and report on wait times and monitor provincial progress in meeting benchmarks for medically acceptable waits. Wait times have become a defining characteristic and benign inconvenience when it comes to finding a solution to chronic pain in Canada’s health care system.
Wait times are based on the need for surgeries and the number of surgeries performed each year. Other factors include the availability of doctors and specialists, operating room schedules, post-surgical beds, changes in patient demographics and issues related to inefficient health care planning by hospitals for medical procedures. Physicians surveyed indicated that their patients are waiting on average three weeks longer than what they consider to be “clinically reasonable” — never mind what patients may consider reasonable. These delays have real consequences for patients including pain, suffering, lost income, poorer medical outcomes, a loss in quality of life and sometimes even death.
The estimated cost to the health care system of waiting for care in Canada reached $1.9 billion last year. That is a costly bill for a lack of efficient care for the 1,040,791 procedures that were in queue in 2017.
The CIHI report noted that in Canada, three out of four patients get the care they need within “benchmark wait times” — the amount of time considered appropriate to wait for a procedure. However, a province-by-province breakdown in the report revealed some glaring gaps in care.
Wait times were compared for hip or knee replacement, cataract surgery, hip fracture repair and cancer radiation therapy. Across Canada, 76 per cent of patients received a hip replacement in 2017 within the recommended six-month wait time, down from 81 per cent in 2015. For knee replacements, 69 per cent of patients had the procedure within the benchmark in 2017, compared to 82 per cent in 2015. One thing is for certain: that is a significant increase in wait times.
In Ontario, more knee surgeries were done in 2017 than in 2015, but wait times still grew. CIHI figures for knee replacements show that 73 per cent of patients nation-wide are being treated within the accepted benchmark period. However, 27 per cent of patients are not. With an average of 60,000 knee replacements taking place annually in Canada, that means more than 15,000 Canadians had to wait more than the benchmark of 182 days for surgery.
In Nova Scotia, only 38 per cent of patients got knee replacement surgery within the recommended time frame, meanwhile in Ontario 81 per cent of patients received care within the benchmark wait time. In Nova Scotia, people needing a hip replacement can expect to wait 750 days, while a knee replacement can take 800 days — a number far above the national average of 182 days. Wait times for more urgent procedures such as hip fracture repair and radiation therapy were steady last year when compared with 2015.
The reality is that Canada is not improving wait time outcomes – it is barely maintaining the status quo.
The CIHI report also noted that timely hip fracture repairs are associated with a reduced death rate. The median wait time to see an orthopedic specialist in Canada was 18.9 weeks in 2014 — after which patients could expect to wait an average of 12-65 weeks (depending on the province) for joint replacement.
A Fraser Institute study (across 12 major medical specialties and 10 provinces) found that while wait times have somewhat stabilized over the last five years, they have done so at a historical high of about 18.2 weeks — almost twice as it would have taken in 1993 (9.3 weeks). The point being that, Canadians have been conditioned to accept that a doubling of the wait time for a procedure over the past 25 years is now “normal”. The study found the longest waiting period between a referral from a GP and a first orthopaedic surgical appointment was almost 40 weeks, and more than 575 days for an operation; that’s ten to twenty months of pain, loss of productivity and decreased quality of life.
The Commonwealth Fund 2017 report that looked at wait times in 11 countries supports the Fraser Institute study. It concluded that Canada fares worse than other countries with universal health care systems when it comes to wait times for specialist appointments and treatments.
Health care professionals and advocates in Canada are searching for better ways to eliminate unnecessary wait times. They note that these delays come at a time when surgical advances and innovations in the treatment of knee, hip and other procedures are more effective, efficient and affordable than ever before.
For an increasing number of Canadians, the idea of waiting for up to two years for surgery to improve their mobility is not an option. The loss in quality of life, in mobility and even in earnings due to cost of elective procedures is something many are not prepared to accept. When physical condition impacts someone’s quality of life, prevents them from sleeping or affects their ability to work or earn a living, time is (quite literally) money. If you're self-employed, a business owner, on long term disability or an employer footing the bill for replacement staff, wait times can have a significant impact on the bottom-line and can even jeopardize a business. With public hospitals’ queuing becoming a widespread trend, patients are increasingly turning to affordable, specialized treatments and hospitalisations out of province or abroad.
