Slide1: Waiting for Health Care in Canada: What We Know and What We Don’t Know


Slide2: Waiting for Health Care in Canada


Slide3: 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


Slide4: Provincial Progress, December 2005 to March 2006 Source: Provincial websites, March 2006. • December 2005 ¤ March 2006


Slide5: No Average Patient, No Average Wait Sources: National Ambulatory Care Reporting System, Statistics Canada, Canadian Joint Replacement Registry and Hospital Morbidity Database, CIHI.


Slide6: The Spectrum of Care


Slide7: 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


Slide8: 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%


Slide9: 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


Slide10: 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.


Slide11: % Who Said Their Waits Were Unacceptable Source: Health Services Access Survey, first 6 months of 2005, Statistics Canada. Percent


Slide12: How Long Do You Wait? Sources: Provincial Data, Canadian Joint Replacement Registry and Discharge Abstract Database, CIHI.


Slide13: Routine Care


Slide14: 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


Slide15: 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 Appointment Wait of 6 Days or More


Slide16: Emergency Department Waits


Slide17: Waits to See a Physician in EDs Source: National Ambulatory Care Reporting System 2003–2004, CIHI.


Slide18: Five Countries—ED Use and Waits in 2004 Source: Primary Care and Health System Performance: Adults’ Experiences in Five Countries, Commonwealth Fund, 2004.


Slide19: Specialist Waits


Slide20: 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.


Slide21: Wait Times for Specialist Visits for a New Illness/Condition, 2005 Source: Health Services Access Survey, first 6 months of 2005, Statistics Canada.


Slide22: MRI / CT Waits


Slide23: 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


Slide24: 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.


Slide25: 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.


Slide26: Growing Numbers of MRI and CT Machines Source: Medical Imaging in Canada, 2005.


Slide27: Waiting for Surgery


Slide28: Growth in Surgical Volumes 1997–1998 to 2003–2004 Sources: Discharge Abstract Database, Hospital Morbidity Database and National Physician Database, CIHI.


Slide29: 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.


Slide30: Waits for Non-Emergency Surgery What Patients Said Source: Health Services Access Survey, 2001, 2003 and first 6 months of 2005, Statistics Canada.


Slide31: 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


Slide32: 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.


Slide33: Waits for Hip Fracture Repair Source: Hospital Morbidity Database, 2003–2004, CIHI .


Slide34: Post-Acute Waits


Slide35: Rehabilitation Waits Waits for Inpatient Rehab Source: National Rehabilitation Reporting System, 2002–2003, CIHI. 0


Slide36: 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.


Slide37: Waiting for Other Types of Care Major Clinical Categories Note: Excludes Quebec and the territories. Source: Discharge Abstract Database, 2004–2005, CIHI.


Slide38: 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%


Slide39: Source: Canadian Joint Replacement Registry and National Rehabilitation Reporting System, CIHI Waits for Joint Replacement Surgery & Rehabilitation Planned versus Unplanned


Slide40: Benchmarks


Slide41: What Are Ministers’ Benchmarks? Source: Federal , Provincial and Territorial Benchmarks, 2005.


Slide42: 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


Slide43: International Comparisons


Slide44: 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


Slide45: 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.


Slide46: Health Services Access Survey (HSAS)


Slide47: 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


Slide48: Volumes and Rates for Priority Areas


Slide49: More and More Cataract Surgeries Source: National Physician Database, CIHI.


Slide50: 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


Slide51: Steady Increase in Joint Replacements Source: Hospital Morbidity Database, CIHI. Rate per 100,000 Population


Slide52: 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.


Slide53: Cardiac Surgery Trends Source: Hospital Mortality Database, CIHI.


Slide54: 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.


Slide55: 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