Surgical rates outside of priority areas remain relatively stable
OTTAWA, June 25 2008 – Over a two-year period, Canadian patients outside Quebec underwent almost 60,000 additional surgical procedures in priority areas targeted for wait time reductions, according to a new study by the Canadian Institute for Health Information (CIHI). In 2004, Canada’s first ministers committed to reduce wait times in four key areas involving surgery: hip and knee replacements, sight restoration, cancer and cardiac revascularization. Between 2004-2005 and 2006-2007, surgical rates in these priority areas increased by 8% overall, after population growth and aging were accounted for. CIHI’s study found that growth was greater in the first year after the first ministers’ agreement (7% in 2005-2006) than in the second year (1% in 2006-2007).
In comparison, the rate of surgical procedures outside of priority areas held steady between 2004-2005 and 2006-2007. While the actual number of operations increased over the two-year period, the surgical rates stayed relatively flat after adjusting for population growth and aging, growing 3% in the first year and decreasing slightly (-2%) in the second.
“Increasing the number of surgical procedures is one strategy used to reduce wait times. After an initial surge of activity in the year following the first ministers’ agreement, our study shows continued but more modest growth in priority areas in 2006-2007,” says Glenda Yeates, CIHI’s president and CEO. “To this point, these additional operations do not appear to have come at the expense of other procedures, but it is important that we continue to monitor these trends.”
Joint replacements and cataract operations account for most of the growth in priority area procedures
In 2006-2007, more than 500,000 Canadians outside Quebec had an operation in one of the four priority areas. Joint replacements and cataract surgery accounted for most of the growth in priority area procedures over the two years since the first ministers’ agreement, with standardized rates for these two procedures up 22% and 13% respectively. The rate of cardiac revascularization procedures remained stable over this time period, while surgical rates for cancer experienced a slight increase (1%).
“While efforts are being made to increase the number of surgical procedures in priority areas, data on who is waiting for what and how long are still evolving,” says Kathleen Morris, a research and analysis consultant at CIHI. “In the meantime, tracking the increase in priority area operations over time, and the effect this increase is having on other operations, offers an interesting snapshot of access to care in this country.”
While the overall number of priority surgical procedures increased in all provinces between 2004-2005 and 2006-2007, there were variations between jurisdictions, both in the size of the increases and in trends by type of procedure. After adjusting for population growth and aging, increases over the two-year period ranged from 2% in Nova Scotia and 4% in Saskatchewan and British Columbia to 11% in Ontario and 15% in Manitoba.
Over the same two-year period, the rate at which surgical procedures were performed outside the priority areas either remained stable or increased in all provinces. Across the provinces, after adjusting for population growth and aging, growth in surgery outside the priority areas was highest in Newfoundland and Labrador (6%), with rates remaining about the same in Alberta, Manitoba and New Brunswick. While overall rates of surgery outside priority areas have been able to keep pace with population growth, there may still be variation by region, facility, specialty or type of procedure.
Supply of key health care providers
The growth in priority area surgical procedures has raised questions about the impact on other services provided by physician specialists, such as consultations with patients. CIHI’s report found that in 2005-2006, the most recent year of data available, specialists provided about the same rate of consultations as they did in previous years.
Questions have also been raised about the broader impact of the emphasis on surgical priorities on health human resources. A more long-term analysis shows that in the five-year period between 2002 and 2006 (during which the population grew by 4%), the number of physicians classified as surgical specialists increased by 2%. Over the same time period, the number of registered nurses reporting surgery as their main area of responsibility increased by 21%, indicating a shift in the kind of work nurses are doing.
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.
The report, as well as the following figure and table, is available from CIHI’s website at www.cihi.ca.
Table 1 Changes in Procedures Within and Beyond Wait Time Priority Areas, 2004-2005 to 2006-2007 (Excluding Quebec)
Figure 1 Two-Year Change in Rates of Surgery Both Within and Outside Wait Time Priority Areas, 2004-2005 to 2006-2007