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Quebec ranks second best in wait times

December 4, 2012

Montreal Gazette

Charlie Fidelman

MONTREAL — Surgical wait times have fallen slightly, but Canadian patients continue to wait too long — about four months on average — for medically necessary treatment, a new report finds.

According to the Fraser Institute’s 22nd annual report on surgical wait times, called Waiting Your Turn, patients face a median wait of 17.7 weeks for treatment — down from 19 weeks last year.

Despite the improvement over last year, Canadians are waiting 91 per cent longer today than they did in 1993 for surgical and other medical procedures. Back then, we waited an average of 9.3 weeks to get treated.

The good news is that Quebec placed second in rankings broken down by province: Ontario has the shortest wait time at 14.9 weeks, Quebec is next at 16.6 weeks, and British Columbia places third with 17 weeks.

However, study authors say even the “least worst” waits are unacceptable.

“Quebec is the second least worst in a very bad bunch,” said Nadeem Esmail, a senior fellow at the Fraser Institute and co-author of the study. “Internationally, wait times in Canada are among the longest in the developing world. The system really is fundamentally broken in terms of treatment of patients in the queue.

“Doctors themselves report that the actual time from specialist consultation to treatment is three weeks longer than what they consider clinically reasonable, overall,” he said.

Quebec is on par with the national average wait time of 9.3 weeks between an appointment with a specialist and treatment. Here again, Ontario did better, with a seven-week wait for a procedure, while B.C. has a 9.8-week wait.

Study authors noted that increased government spending has failed to reduce wait times over the past decade, while some European countries such as Austria, Belgium, France, Germany, Luxembourg, the Netherlands and Switzerland are spending less on health care while performing better, Esmail said.

Top performing countries have turned to “cost sharing,” that is, user-fees and the private sector to help finance and deliver health care, said Esmail, whose institute is described as a right-leaning Canadian think-tank.

Quebec did relatively well in Canada because it has “a larger parallel health-care sector than exists in other provinces,” Esmail added.

But critics dismissed the Fraser Institute study as flawed because it draws on survey responses from medical practitioners rather than measurable data. Questionnaires went to practitioners in 12 specialties: plastic surgery, gynecology, ophthalmology, otolaryngology, general surgery, neurosurgery, orthopedic surgery, cardiovascular surgery, urology, internal medicine, radiation oncology, and medical oncology.

Only 18 per cent of those surveyed, or 1,801 doctors, responded. In Quebec, 10 per cent of those polled, or 257 doctors, replied.

Although it’s true that wait times for elective surgeries are longer than anyone would like, Canada has a very good track record for urgent care and does not compare poorly with other countries, said Danielle Martin, chair of Canadian Doctors for Medicare.

“Our urgent wait time is extremely short,” Martin said.

Canada has among the lowest doctor-to-population ratio among developed countries, and luring physicians to the private sector will not fix wait-time problems, Martin said.

“It will leave those who can’t afford to pay on a longer wait list,” Martin said. The Fraser Institute “would like to see us moving from a system that allocates care according to need to a system that allocates care according to who can pay.”

“I don’t think that’s something Canadians are interested in.”

According to the institute’s own report, the wait time for urgent heart surgery is down to less than a week in 2012 from 2.7 weeks in 1993. Waits for elective cardiovascular surgery also dropped, to 4.4 weeks from 9.8 weeks.

Reports from the Canadian Institute for Health Information show wait times have declined for five procedures over the past five years: knee and hip replacements, hip fractures, cataracts, cardiac bypass, and radiation for cancer.

“We’re seeing dramatic decrease in the wait and that’s not by asking people to pay for their surgery, or pumping more money into the system,” Martin said. Most of the changes came from reorganizing care; for example, giving doctors access to operating rooms and fast-tracking patients to the right care so they do not mistakenly fill spots on the wrong waiting lists.

About 4,500 Quebec patients are waiting for surgical procedures longer than six months. The latest provincial statistics suggest that nearly 3,000 of them are in the Montreal area. However, the information is 10 months old, and Quebec health officials have not released more up-to-date data.

Quebec hospitals report surgical wait times to their regional health agencies on a daily basis. But the Montreal Health and Social Services Agency referred The Gazette to the Quebec Health Department, which has not updated its surgical wait time statistics on its website since February.

The department is modernizing its computer information system, explained spokesperson Noémie Vanheuverzwijn, and new data will not be available for weeks.

Meanwhile, Quebec oncologists have been reporting that their patients are waiting four to six months for surgery to remove aggressive tumours, especially for gynecological cancers.


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