1. Waiting for Health Care in Canada: What We Know and What We Don’t Know

2. Waiting for Health Care in Canada

3. Variety of Data Sources Used for Waiting for Health Care in Canada Provincial/territorial wait times data Primarily for surgery, subject to availability, as of December 2005 New analysis of CIHI data Rates, MRI/CT, unplanned surgery, joint replacement trajectory, rehabilitation, etc. Health Services Access Survey (self-reported) For early waits and other access issues, etc. Commonwealth Fund (self-reported) International comparisons

4. ProvinceCancerCardiacDiagnostic Imaging Joint ReplacementSight Restoration N.L. ¤¤¤ P.E.I. ¤ ¤ N.S. N.B. ¤¤ Que. ¤ Ont. Man. ¤ Sask. Alta. B.C. Y.T. ¤¤ N.W.T. ¤¤ Provincial Progress, December 2005 to March 2006 Source: Provincial websites, March 2006. December 2005 ¤ March 2006

5. No Average Patient, No Average Wait Care Area10%— Shortest Waits 50%10%— Longest Waits Emergency department wait to physician initial assessment 10 minutes51 minutes165 minutes Hip fracturesame daynext day3 days Non-emergency MRI/CT/angiography 1 day3 weeks4 months Specialistsa few days1 month4 months Non-emergency surgerya few days1 month6 months Hip replacement (specialist to surgery) <1 month4.5 months14 months Knee replacement (specialist to surgery) 1–2 months7 months21 months Sources: National Ambulatory Care Reporting System, Statistics Canada, Canadian Joint Replacement Registry and Hospital Morbidity Database, CIHI.

6. The Spectrum of Care

7. A Patient’s Journey A patient’s journey can be made up of a series of waits: For routine care To see a specialist For tests For results For surgery For post-acute care

8. Source: Canadian Joint Replacement Registry, April to December 2005, CIHI. Waiting for a Joint Replacement Referral to Specialist Specialist Appointment Decision to Operate Surgery 30%10%60%

9. Waiting for a Joint Replacement One Person’s Story A patient sees her GP about hip trouble and is referred to a specialist (clock starts). On average: 30% of the wait is to see a specialist 10% of the wait is for tests and decision to operate 60% of the wait is for surgery Source: Canadian Joint Replacement Registry, April to December 2005, CIHI. 30% 10% 60% Referral to Specialist Specialist Appointment Decision to Operate Surgery

10. Who Needs Care? 1 in 8 adults required a visit to a medical specialist 1 in 11 required non-emergency diagnostic tests (MRI, CT, angiography) 1 in 15 required non-emergency surgery Source: Health Services Access Survey, first 6 months of 2005, Statistics Canada.

11. % Who Said Their Waits Were Unacceptable Source: Health Services Access Survey, first 6 months of 2005, Statistics Canada. Percent

12. How Long Do You Wait? Type of SurgeryMedian Wait Hip fracture surgeryNext day (day after admission) Cardiac surgery Days to weeks Cataract surgery A few months Joint replacement Months (with knees > hips) Sources: Provincial Data, Canadian Joint Replacement Registry and Discharge Abstract Database, CIHI.

13. Routine Care

14. Waiting for Routine Care Source: Health Services Access Survey, 2003, first 6 months of 2005, Statistics Canada. More than half of Canadian adults (56%) sought routine or ongoing care in 2005 Of these, one in six said they had trouble getting routine care 1.2 million Canadian adults said they were unable to find a family doctor in 2003

15. Access to Doctor When Sick or Need Medical Attention Source: Primary Care and Health System Performance: Adults’ Experiences in Five Countries, Commonwealth Fund, 2004. Same Day AppointmentWait of 6 Days or More

16. Emergency Department Waits

17. Waits to See a Physician in EDs Source: National Ambulatory Care Reporting System 2003–2004, CIHI.

18. AUS % Canada % NZ % UK % US % Went to the emergency department in the last 2 years 2938272934 Went to the emergency department, but felt they could have been treated by regular doctor if available 9187616 Reported waiting >2 hours before being treated 2948273634 Five Countries—ED Use and Waits in 2004 Source: Primary Care and Health System Performance: Adults’ Experiences in Five Countries, Commonwealth Fund, 2004.

19. Specialist Waits

20. International Comparisons of Patients Who Waited More Than Four Weeks to See a Specialist Note: Patients are adults with health problems. Source: 2005 International Health Policy Survey, Commonwealth Fund.

21. Wait Times for Specialist Visits for a New Illness/Condition, 2005 Source: Health Services Access Survey, first 6 months of 2005, Statistics Canada.

22. MRI / CT Waits

23. Diagnostic Imaging Non-Emergency MRI, CT, Angiography Source: Health Services Access Survey, 2001, 2003 and first 6 months of 2005, Statistics Canada. 400,000 more patients seen

24. 200120032005 25% of patientsWaited 1 week or less 50% of patientsWaited 3 weeks or less 75% of patientsWaited 2 months or less But 10% of patientsWaited 3–4 months or more Waits for Non-Emergency MRI, CT and Angiography What Patients Said Source: Health Services Access Survey, 2001, 2003 and first 6 months of 2005, Statistics Canada.

25. Waiting for MRI/CT Results From 2005 Snapshots Median waits longer for MRI than CT Most clinical/diagnostic scans are outpatients 2 in 3 CT scans 9 in 10 MRIs Median waits vary by type of patient Typical emergency department and hospital inpatients wait <1 day for CT Median wait for outpatient CT is several weeks Source: Snapshots 2005, CIHI.

26. Growing Numbers of MRI and CT Machines Source: Medical Imaging in Canada, 2005.

27. Waiting for Surgery

28. Growth in Surgical Volumes 1997–1998 to 2003–2004 Sources: Discharge Abstract Database, Hospital Morbidity Database and National Physician Database, CIHI.

29. Waiting for Non-Emergency Surgery Adults With Health Problems Who Had Surgery in Last 2 Years, 2005 Source: 2005 International Health Policy Survey, Commonwealth Fund.

30. 200120032005 25% of patientsWaited 2 week or less 50% of patientsWaited 1 month or less 75% of patientsWaited 3 months or less But 10% of patientsWaited 5–6 months or more Waits for Non-Emergency Surgery What Patients Said Source: Health Services Access Survey, 2001, 2003 and first 6 months of 2005, Statistics Canada.

31. Factors Influencing Waits What type of care you need Whose list you are on How urgently you need care Special factors related to individual patients or conditions

32. Hip Replacement Knee Replacement 4.5 months 7 months Wait for Joint Replacement Surgery Median Wait From Decision-to-Treat to Surgery Source: Canadian Joint Replacement Registry April to December 2005, CIHI.

33. Waits for Hip Fracture Repair Source: Hospital Morbidity Database, 2003–2004, CIHI.

34. Post-Acute Waits

35. Rehabilitation Waits Waits for Inpatient Rehab Source: National Rehabilitation Reporting System, 2002–2003, CIHI. 0

36. Waiting to Leave Hospital Programs With Highest % of Patients Waiting At least 3% of inpatients wait for an alternative level of care before leaving the hospital Note: Excludes Quebec and the territories. Source: Discharge Abstract Database, 2004–2005, CIHI.

37. Waiting for Other Types of Care Major Clinical Categories Note: Excludes Quebec and the territories. Source: Discharge Abstract Database, 2004–2005, CIHI.

38. Waiting to Leave Hospital Where Alternative Level of Care (ALC) Patients Go Note: Excludes Quebec and the territories. Source: Discharge Abstract Database, 2004–2005, CIHI. Other Inpatient Facility 9% Home 32% Transferred to Inpatient Rehabilitation Facility 10% Died 9% Transferred to Continuing Care Facility 40%

39. Planned Hip Replacement Unplanned Hip Replacement Following Hip Fracture Wait for surgeryMedian— 4.5 months Median—next day % of patients who go to rehabilitation 21% 24% Source: Canadian Joint Replacement Registry and National Rehabilitation Reporting System, CIHI Waits for Joint Replacement Surgery & Rehabilitation Planned versus Unplanned

40. Benchmarks

41. What Are Ministers’ Benchmarks? Treatment AreaBenchmark Radiation therapy for cancerWithin 4 weeks of being ready to treat Surgical repair of hip fractures Within 48 hours Cardiac bypass surgery2–26 weeks depending on urgency Hip replacement26 weeks Knee replacement26 weeks Cataract removalWithin 16 weeks for high-risk patients Source: Federal, Provincial and Territorial Benchmarks, 2005.

42. Performance vs. Ministers’ Benchmarks Most often have data on typical patients Provincial reporting systems predate recent agreement on benchmarks Many—in some cases most— patients receive care within the new benchmarks Not all do, and some patients face significantly longer waits—exactly how many is not clear

43. International Comparisons

44. Commonwealth Fund (CMWF) Survey Approach 5 to 6 country survey, including United States, Australia, Canada, New Zealand, United Kingdom and Germany Telephone interview by Harris Interactive Random representative samples of adults 18 and older (2004); adults with health problems (2005) Sample size varies from 700 to 3,000 adults per country

45. Canada/U.S. Comparison of Unmet Needs 2002– 2003 Same % of Canadians (11%) and Americans (13%) report unmet health care needs Of those reporting unmet needs, the primary barrier sited was: “Waiting for care” for 32% of Canadians “Cost” for 53% of Americans Source: Joint Canada-US Health Survey, Statistics Canada/NCHS.

46. Health Services Access Survey (HSAS)

47. HSAS Survey Approach HSAS is a sub-sample of the Canadian Community Health Survey Cross-sectional data Collected by personal and telephone interviews HSAS covers approximately 98% of the population of Canadians aged 15 and older living in private dwellings in 10 provinces

48. Volumes and Rates for Priority Areas

49. More and More Cataract Surgeries Source: National Physician Database, CIHI.

50. Regional Variations in Rates of Cataract Surgeries 2003–2004 Sources: National Physician Database and Discharge Abstract Database, CIHI. 1064 898 1169 873 1007 964 1154 1038 677 992 Canadian Average 661

51. Steady Increase in Joint Replacements Source: Hospital Morbidity Database, CIHI. Rate per 100,000 Population

52. Regional Variations in Joint Replacements 2004–2005 Knees Hips 75 95 78 101 81 121 67 93 75 107 64 100 76 104 87 106 47* 50 67 57 45 99 139 69 279 60* *Quebec rate for 2003–2004. Source: Hospital Mortality Database, CIHI.

53. Cardiac Surgery Trends Source: Hospital Mortality Database, CIHI.

54. Regional Variations in Coronary Artery Bypass Surgery and Angioplasty (PCI) 2004–2005 CABG PCI 179 73 149 72 176 111 126 87 164 91 199 80 167 94 153 78 200* 132 134 211 100 63 95 108 30 98* *Quebec rate for 2003–2004. Source: Hospital Mortality Database, CIHI.

55. Where We Stand We know more than before; still more to learn Marked increase in provincial reporting; comparability is limited No average patient, no average wait Many waits across a patient’s journey Volumes increased in priority areas Waits for non-emergency surgery and major diagnostic tests are about the same since 2001