Canadians Begin Waiting For Surgery Before Getting On The “Wait List”

New CIHI report pulls together health services wait times information from across Canada, providing a guide to who is waiting for what and for how long.

March 7, 2006 – Much of the attention on waiting for health care focuses on surgical and diagnostic imaging wait lists. New data show that, at least in some cases, waiting to see a specialist also makes up a significant proportion of the overall waiting period for care. For example, in the case of hip and knee replacement patients, nearly one-third of the time between referral to a specialist and surgery was spent waiting for an initial visit to the orthopedic surgeon.

This is just one of the findings released today by the Canadian Institute for Health Information (CIHI) in Waiting for Health Care in Canada: What We Know and What We Don’t Know. This new report compiles information from various data sources to provide a unique picture of waits for assessment and diagnosis, surgery and post-acute care.

Waiting too long was the leading barrier to getting care, according to Canadian adults who reported difficulties accessing specialist care for a new illness or condition, non-emergency diagnostic imaging or non-emergency surgery in a 2005 Statistics Canada survey.1

“Understandably, Canadians care deeply about how long they and their loved ones have to wait for care,” says CIHI President and CEO Glenda Yeates. “And while we know a lot more about wait times now than we did just a year ago, we do not yet have a comprehensive, cross-Canada picture.”

Waiting to see a specialist

In 2005, 2.8 million Canadian adults said that they had visited a specialist for a new illness or condition. Half reported waiting four weeks or less, but some had much longer or shorter waits. Eighty-eight percent said that their visit took place within three months.

Following a specialist visit, some patients need further care. For example, new data from CIHI on hip and knee replacements tracked waits between the referral to a specialist and surgery for patients in 2005. On average, 30% of the total wait was spent waiting for an initial appointment with the orthopedic surgeon. Another 10% of the time went by before the decision was made to have surgery. The wait for surgery itself, sometimes several months, constituted on average about 60% of the total waiting time. Data reflect submissions from selected orthopedic surgeons in eight provinces.

Waiting for diagnostic tests

Canada is performing more MRI and CT exams than ever before, but typical wait times have not changed in recent years. In a 2005 survey, half of the 2.1 million adults who had a non-emergency MRI, CT or angiography in the past year reported waiting three weeks or less. Ninety percent reported that their tests took place within four months. Canadians tend to wait longer for MRI exams than for CT exams, according to provincial wait times data and a CIHI snapshot survey.

How long you wait depends on what type of patient you are. For example, most CT exams are for outpatient diagnostic purposes with typical waits of a few weeks, although some patients wait less or more time. In contrast, one in three patients requiring a CT exam are referred while in a hospital emergency department or inpatient bed. This group typically will have their exam on the day it was requested or the next day. A smaller number of other patients (12%) are scheduled to have a follow-up exam—meaning a period of time must go by before the next exam takes place. The extent to which follow-up exams are included in current wait times reporting is unknown.

Waiting for surgery: the four priority areas

In 2005, half of the 1.5 million adults who had non-emergency surgery in the past year reported waiting 30 days or less, according to a Statistics Canada survey. Ten percent said they waited six months or more. According to survey results, an estimated 162,000 adults experienced difficulty getting non-emergency surgery.

Governments have agreed on four priority areas for reducing surgical wait times: cardiac care, sight restoration (cataract surgery), orthopedics and cancer. “Measuring wait times is challenging,” says CIHI Vice President of Research and Analysis, Jennifer Zelmer. “Most provinces monitor some surgical wait times, but the level and nature of tracking varies greatly.”

Across the country, the data show that wait times tend to be longest for knee replacements, followed by hip replacements and cataract surgery. Typical waits for cardiac procedures tend to be shorter.

Cardiac surgery: The number of angioplasty and bypass surgeries had a combined increase of 51% over five years between 1997-1998 and 2002–2003, amounting to almost 22,000 more surgeries over this period. A group of patients we know most about are new heart attack patients who have angioplasty or bypass surgery within a year. According to CIHI analysis, half of this group waited four days or less for angioplasty and two-and-a-half weeks or less for bypass surgery. However, the 10% of patients who waited the longest had waits that were six or more times longer than those of typical patients.

  • Provincial reporting-As of December 2005, seven provinces reported wait times for bypass surgery. Wait times tend to be longer in provinces that track wait times for elective cases only, compared with those that capture waits for both elective and emergency bypass surgeries. Fewer provinces tracked wait times for angioplasty and cardiac catheterization. Alberta, British Columbia, Manitoba, Newfoundland and Labrador, New Brunswick, Nova Scotia, Ontario, Quebec and Saskatchewan reported wait times for bypass and/or cardiac surgery.

Hip fractures: In 2002–2003, the number of Canadians hospitalized for hip fractures increased by 2% from five years earlier. In 2003–2004, seven out of eight Canadians underwent surgery to repair a hip fracture within two days of being admitted to hospital, according to new CIHI analysis based on hospital administrative data.

  • Provincial reporting-In December 2005, health ministers adopted a common goal of hip fracture fixation within 48 hours. At that time, no provinces specifically reported wait times for hip fracture surgeries on their Web sites. Some information is, however, available from existing administrative databases.

Joint replacements: Joint replacement surgeries grew significantly in the five years leading up to 2002-2003. Together, knee and hip replacement surgeries increased 30%, amounting to 11,340 more surgeries over this period. According to the Canadian Joint Replacement Registry, waits for a knee replacement are longer than for a hip replacement, with half of all patients undergoing surgery within seven months for knees and four-and-a-half months for hips. However, 10% of knee replacement patients wait 21 months or more, while 10% of hip replacement patients wait 15 months or more. These results reflect submissions from selected orthopedic surgeons in eight provinces.

  • Provincial reporting-As of December 2005, eight provinces reported estimates of wait times for hip and knee replacements. Those reporting wait time distributions (rather than just an average or median) showed that a portion of patients undergo surgery within a few weeks, while others wait a year or more. Alberta, B.C., Manitoba, Nova Scotia, Ontario, P.E.I., Quebec and Saskatchewan reported wait times for joint replacements.

Cataract surgery: There was a 32% increase in cataract surgeries over five years, between 1997–1998 and 2002-2003, amounting to more than 62,000 additional cataract surgeries over this period. In December 2005, health ministers set a goal to provide cataract surgery within 16 weeks for patients at high risk. Substantial differences in the way data are collected make interprovincial comparisons difficult.

  • Provincial reporting-As of December 2005, Alberta, B.C., Nova Scotia, Ontario, Quebec and Saskatchewan reported wait times for cataract surgery. However, none of the provinces provide wait times by risk group.

Cancer: Tracking cancer care is complex because of the diversity in the types of cancer and the types of treatment. As of December 2005, very little comparable wait time data were available for the various cancer surgeries . However, more provinces track wait times for radiation therapy than for cancer surgery or chemotherapy.

  • Provincial reporting-In December 2005, healthministers set benchmarks to provide radiation therapy within four weeks of a patient being ready to treat. Wait times reported by six provinces suggest that median waits are currently below this point for at least some facilities and body sites in each jurisdiction reporting wait times. Alberta, B.C., Manitoba, Nova Scotia, Ontario and P.E.I. reported wait times for radiation therapy.

“Tracking wait times is a complicated business—identifying where the waits are occurring, ensuring comparable measurements from clinic to clinic, hospital to hospital and province to province,” says CIHI Board Chair Graham W.S. Scott C.M., Q.C. “Wait time measurement and reporting have improved, but there is still much work to be done with the provinces on making data more comparable across the country. The goal is to create a comprehensive picture of access to care in the future.”

Since data were collected from provincial Web sites for this report, some governments have increased their reporting.

About CIHI

The Canadian Institute for Health Information (CIHI) collects and analyzes information on health and health care in Canada and makes it publicly available. Canada’s federal, provincial and territorial governments created CIHI as a not-for-profit, independent organization dedicated to forging a common approach to Canadian health information. CIHI’s goal: to provide timely, accurate and comparable information. CIHI’s data and reports inform health policies, support the effective delivery of health services and raise awareness among Canadians of the factors that contribute to good health.

1 Results for 2005 are preliminary based on data collected from Canadians aged 15 and over during the first half of the year.