The issue of wait times in the public health system has long been a source of worry for Canadians, and in some jurisdictions it’s still a significant problem. The Canadian Institutes of Health Information (CIHI) recently released its report for 2015. It offers both encouraging news and a path for the future.

CIHI follows the wait times for a set of medical interventions across all jurisdictions in Canada, including cancer care (radiation), cataract removal, surgery for hip fractures and total joint replacements of the hip and knee. In each instance, CIHI asks the question: How many of the people who need treatment get it in a timely fashion?

(Establishing what constitutes “timely treatment” can be contentious, but in 2004, the provinces and territories agreed to standards for wait time maximums based on the best available evidence. CIHI continues to deploy these benchmarks.)

First, the good news: Wait times have remained stable over time, in spite of increased demand. For example, the numbers of patients receiving radiation therapy has grown by 34 per cent since 2010, yet 98 per cent of patients are treated within the benchmark. Surgery for hip fractures has shown an improvement of 6 per cent for timeliness. Eighty-three per cent of hip replacements were performed within benchmark, while 79 per cent of knee replacements made the mark. For cataract surgery, the number within benchmark was 80 per cent.

Unfortunately, CIHI is not able to address the question of appropriateness of treatment. The critical question — does this patient really need this surgery now? — remains unanswered.

Timely care isn’t enough; it also has to be the right care. We must do a better job of finding the rationale for treatment in the first place. Timely care isn’t enough; it also has to be the right care. We must do a better job of finding the rationale for treatment in the first place.

Other studies show Canadian wait times in a more mixed light. In an OECD study, Canada fares well in terms of timeliness of access compared to six OECD peer countries (United Kingdom, Australia, New Zealand, Finland, Estonia and Portugal), ranking first in cataract surgery and second in knee and hip replacements. (The other two interventions are not tracked in the other nations.)

But a third study by the Commonwealth Foundation found that Canada does not fare well compared to peer nations with universal health care when it comes to accessing appointments for primary care and consultations for specialty care. Since accessibility is one of the five core principles of the Canada Health Act, this is something that needs urgent attention — especially since delays in accessing services would add to total wait times.

So there’s room for improvement. At least we know where to start; the means to address the problems of wait times and appropriateness of care are already being deployed successfully in Canada, through the work of bodies like the Cardiac Care Network in Ontario, the Alberta Bone and Joint Institute and the Choosing Wisely Canada initiative of the Canadian Medical Association.

Best practices not only enhance health care efficiency, they result in substantial economic savings — a minimum of 15 per cent, according to most analyses. So how do we get there?

Effective wait time management requires support from government leaders as well as cooperative administrative and clinical leadership. It requires information technology infrastructure support to manage centralized wait lists, and a committed full-time staff monitoring wait times, measuring performance against benchmarks and identifying ‘outliers’ — patients who are experiencing untoward delays.

With these elements in place, a system can be created that can track broad trends and identify individual problems.

But timely care isn’t enough; it also has to be the right care. We must do a better job of finding the rationale for treatment in the first place: Is this knee replacement really necessary now? Should the patient lose weight instead, or opt for non-surgical management? In health care, ‘when’ is never the only question; ‘why’ and ‘how’ matter too.

Robert Y. McMurtry is an expert advisor with EvidenceNetwork.ca, an active orthopedist and formerly Dean of Medicine at Western University and assistant deputy minister of Health Canada. He was a special medical advisor to the Royal Commission of the Future of Health Care in Canada (Romanow Commission).

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