Canada - Waiting for access
- From: J <macyinno@xxxxxxxxxx>
- Date: Mon, 18 Sep 2006 07:42:31 -0400
"It's almost totally up to individual physicians to draw up lists of
people who need access to the system."
http://www.cbc.ca/news/background/healthcare/waiting.html
Waiting for access
CBC News Online | September 10, 2004
Long waiting times are the main, and in many cases, the only reason some
Canadians say they would be willing to pay for treatments outside of the
public health care system.
- Roy Romanow in his report on the future of health care in Canada,
November 2002
MRI at a public hospital in Calgary (CP PHOTO/Adrian Wyld)
Long waits for diagnostic tests, access to specialists and some surgeries
have long been at the heart of complaints about the failings of Canada's
health care system. Fix that, Roy Romanow concluded in his $15-million
report, and Ottawa will go a long way towards satisfying Canadians'
concerns about medicare.
In his report on how to fix medicare, Senator Michael Kirby recommended
that the government should pay for out-of-province or out-of-country
treatment for patients who don't receive timely care.
Romanow figured the problem could be handled with a little cash and some
organization. Two key recommendations to come out of his report were:
* The creation of a Diagnostic Services Fund to improve access to
medically necessary diagnostic services.
* Provincial and territorial governments should take immediate action
to manage wait lists more effectively by centralized approaches, setting
standardized criteria, and providing clear information to patients on how
long they can expect to wait.
Romanow reasoned that access to necessary diagnostic services ? like MRIs
and CT scans ? can create bottlenecks in the rest of the health-care
system by extending waiting times for patients who need tests to confirm a
diagnosis before surgery or further treatment. He concluded that by
focusing on diagnostic services, the provinces and territories would be
able to make better choices regarding the equipment and staff on which
they should be spending more money.
In the 2004 federal election campaign, Prime Minister Paul Martin proposed
a Waiting Times Reduction Fund of $4 billion, giving a title to
commitments reached at a first ministers conference on health care a year
earlier.
At the same time, Martin promised to significantly cut waiting times in
five key areas by the end of 2009:
* Cancer treatment.
* Cardiac care.
* Diagnostic imaging.
* Joint replacements.
* Sight restoration.
Part of the plan would be to publish estimated waiting times for each of
the five areas across the country ? by the end of 2005.
Some provinces offer variations of that service. But the quality of
information varies widely.
For instance, the health ministries of B.C., Alberta, Saskatchewan,
Manitoba and Quebec allow you to search for estimated wait times for
several surgical procedures. In Quebec, you can check estimated waiting
times by hospital. The site notes that the information is not meant to
allow the user to "shop around" for the shortest waiting list.
Ontario does not offer such a service, but the system it uses to manage
information about who needs cardiac services has been praised as one of
the best in North America.
The Cardiac Care Network of Ontario (CCN) has devised a provincewide
rating system. Those with the most urgent need for an angiogram,
angioplasty or bypass surgery go to the top of the list. Each of the
province's 17 cardiac care centres has a co-ordinator who receives
patients' test results, gets people on the list and starts looking for
room across the province.
"We page each other when we have an urgent case that needs surgery within
a 24-hour time frame," Kathleen Brown, one of 17 CCN co-ordinators told
CBC-TV's The National. "We'll ask them, 'what is your list like, what is
your opening' even though we have assessed the patient."
Ontario is the only province in the country to handle cardiac patients
this way. Traditionally, physicians and surgeons keep waiting lists of
their own patients.
But the CCN system has some limitations. It doesn't track people until
they've seen a cardiologist, which for many people, can be the longest
wait in the system. The network's information is still organized by phone
and fax so by the time lists are entered into a database they can be up to
two months out of date. The network has asked the Ontario government to
pay for a multimillion-dollar software update to get real-time
information.
In Newfoundland and Labrador, the St. John's Health Care Corporation, has
begun the process of determining how to cut waiting times by hiring a wait
time manager, who will have the task of researching the problem and coming
up with solutions.
George Tilly, the corporation's CEO, says without the full picture he'll
just have to trust the politicians to make the right move.
"We have some very crude data that would tell us that we can do better in
terms of access for cardiac surgery, for urology surgery and access to our
MRI [machines]. If there was additional available, targeted funding for
that purpose, instead of into the general system at large, then I really
think it has the potential of benefiting us."
In Newfoundland, the wait for an MRI has typically been a year. Tilly says
it should be three months at the most. The wait for a mammogram averages
14 months. In other provinces, it's weeks.
The Canadian Health Coalition has long called on doctors and hospitals to
make their waiting time lists public. The coalition's Mike McBain says it
would allow patients to shop around for better service. But at the same
time, he warns, waiting will always be a part of medicine.
"Hospitals operate on the basis that urgent patients get care first,"
McBain told CBC News. "And I don't want a politician to decide what's more
important and what has to be worked on ? on a priority basis ? and
everybody else waits. Those are medical decisions."
That's something else that has concerned health commissioner Roy Romanow.
He points out there are few rules that govern when ? or if ? someone
should be put on a wait list for a particular service. It's almost totally
up to individual physicians to draw up lists of people who need access to
the system. And without the infrastructure to determine how to deal
efficiently with those lists, the waiting will continue.
.
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