15th Fraser alarm on queues in Canada
Waiting Your Turn: Hospital Waiting Lists in Canada, 15th Edition
By Nadeem Esmail and Michael Walker
The Fraser Institute
October 2005
Total waiting time between referral from a general practitioner and treatment, averaged across all 12 specialties and 10 provinces surveyed, fell from 17.9 weeks in 2004 back to the 17.7 weeks last seen in 2003.
The 2005 Waiting Your Turn survey indicates that waiting times for medical treatment in Canada have fallen slightly from 2004, but remain at a very high level historically. Even if one debates the reliability of waiting list data, this survey reveals that specialists feel their patients are waiting too long to receive treatment.
The survey was conducted in all 10 Canadian provinces. Cornerstone List Fulfillment provided mailing lists, drawn from the Canadian Medical Association’s membership rolls, for the specialists polled. Specialists were offered a chance to win a $2,000 prize (to be randomly awarded) as an inducement to respond. Survey questionnaires were sent to practitioners of 12 different medical specialties: plastic surgery, gynaecology, ophthalmology, otolaryngology, general surgery, neurosurgery, orthopaedic surgery, cardiac and vascular surgery, urology, internal medicine, radiation oncology, and medical oncology.
http://www.fraserinstitute.ca/shared/readmore.asp?sNav=pb&id=801
A question from the survey (Appendix 2):
4. From today, how long (in weeks) would a new patient have to wait for the following types of elective surgery or diagnostic procedures? What would you consider to be a clinically reasonable waiting time for these types of surgery and procedures?
Chart 14: Median Actual Wait Versus Median Clinically Reasonable Wait by Specialty for Canada: Weeks Waited from Appointment with Specialist to Treatment in 2005
(median actual wait/median clinically reasonable wait)
Plastic Surgery (20.9/10.0)
Gynaecology (7.1/5.4)
Ophthalmology (13.1/7.7)
Otolaryngology (9.0/5.9)
General Surgery (6.2/4.0)
Neurosurgery (7.8/4.3)
Orthopedic Surgery (25.3/10.0)
Cardiovascular Surgery - urgent (1.1/0.7)
Cardiovascular Surgery - elective (5.2/4.2)
Urology (5.3/3.5)
Internal Medicine (6.3/3.1)
Radiation Oncology (4.1/3.7)
Medical Oncology (2.6/2.6)
http://www.fraserinstitute.ca/admin/books/chapterfiles/wyt2005.pdf#
Comment: It is important that reform advocates understand this report. It is the primary source used by the opposition to condemn the Canadian health care system for its outrageous delays in providing access to life-saving care. It is the product of The Fraser Institute, an organization which, according to their mission statement, “has as its objective the redirection of public attention to the role of competitive markets in providing for the well-being of Canadians.”
The study was limited to Canadian specialists, heavily weighted toward procedural rather than cognitive fields. This sector of physicians represents those who have a bias toward privatization since the market allows more freedom to enhance personal income. These individuals have an interest in demonstrating that the public system is a disaster and that patients must be granted the option to buy their way to the front of the queue. Fraser understands this sector well since they knew that they could entice a greater response by offering a cash reward.
When the specialists were asked to estimate the actual wait versus the reasonable wait, they listed them in two columns, side by side. So not only were they motivated to estimate greater delays, they were also motivated to provide estimates that would confirm that these were unreasonable delays.
What did the results show? For most specialties, the differences were not that unreasonable. When correcting for bias, the only real differences were in orthopedic surgery, plastic surgery and ophthalmology. (Internal medicine is a special case, not addressed here.) There is a need to increase capacity for orthopedics and ophthalmology, and efforts to do so are already underway.
One of the most disconcerting claims that we see in the conservative literature is that people are dying because they can’t gain timely access to urgent cardiovascular surgery or to treatment of their newly diagnosed malignancies. Even this biased study confirms that such claims are pure fiction.