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
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
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.
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
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%
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
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.
% Who Said Their Waits Were Unacceptable Source: Health Services Access Survey, first 6 months of 2005, Statistics Canada. Percent
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.
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
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
Waits to See a Physician in EDs Source: National Ambulatory Care Reporting System 2003–2004, CIHI.
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.
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.
Wait Times for Specialist Visits for a New Illness/Condition, 2005 Source: Health Services Access Survey, first 6 months of 2005, Statistics Canada.
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
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.
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.
Growing Numbers of MRI and CT Machines Source: Medical Imaging in Canada, 2005.
Growth in Surgical Volumes 1997–1998 to 2003–2004 Sources: Discharge Abstract Database, Hospital Morbidity Database and National Physician Database, CIHI.
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.
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.
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
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.
Waits for Hip Fracture Repair Source: Hospital Morbidity Database, 2003–2004, CIHI.
Rehabilitation Waits Waits for Inpatient Rehab Source: National Rehabilitation Reporting System, 2002–2003, CIHI. 0
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.
Waiting for Other Types of Care Major Clinical Categories Note: Excludes Quebec and the territories. Source: Discharge Abstract Database, 2004–2005, CIHI.
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%
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
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.
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
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
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.
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
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