Ontario has one of the worst international track records for access to specialists, with half of the sickest patients waiting too long, according to an agency that tracks the performance of the province’s health system.

“That’s one area where we fare very poorly compared to other jurisdictions,” said Dr. Ben Chan, president of Health Quality Ontario, an arm’s length agency of the provincial government.

Long wait times — for specialist care as well as other health services — was a major theme in the agency’s annual report, which pinpoints wanting areas of Ontario’s health system.

The report states that half of Ontarians with complex-care needs wait four weeks or more to see a specialist.

“Ontario and Canada are tied with Norway for the worst standing among 11 countries in achieving timely access to specialist care,” states the report.

The agency cast its net wide for sources of information, and the data on specialist wait times comes from the highly regarded Commonwealth Fund International Health Policy Survey.

The best performing county is Switzerland, where only 7.1 per cent of patients with complex-care needs wait four or more weeks, followed by the United States, where 10.6 per cent of the sickest patients wait that long.

Noting that more specialists have been graduating from medical schools in recent years, Chan said more doctors isn’t necessarily the solution.

“We need to start thinking about how best to use the resources that we have. Part of the solution may be rethinking the ways in which we are using our specialists,” he told a news conference on Thursday.

As an example, he cited the back-and-forth, “rigid” system of referrals to specialists by family physicians. What would work better, Chan said, is a system in which specialists were closely linked with family practices. Specialists could then offer advice on a number of patients and serve as mentors to family physicians, helping with the toughest cases.

On wait times, the agency found that while there have been improvements in some areas, such as CT scans and MRIs, waits for urgent surgeries are too long. One third of urgent cancer, and hip and knee replacement surgeries are not done within the recommended time frames.

Waits for hip and knee replacements and cataract surgery grew by about three weeks between 2005 and 2009, even though they are procedures that have been targeted for cuts in waits by the province.

While emergency department waits have decreased by about half an hour over the past three years, they are still too long, the report says. The average wait for high-complexity patients is 11.5 hours, and for low-complexity patients it’s 4.4 hours. Provincial targets are eight and four hours, respectively.

“All sections of this report point to one overall theme. Progress is being made in many areas but the rate of change has been slow. The rate of progress needs to be accelerated,” Chan said.

He warned that Ontario’s health-care system is “under intense pressure” from a combination of if spiralling costs, an aging population and government budgetary austerity.

While waits for long-term care have not gone up in the past two years, they are still too long with a median wait of 113 days, the report states.

But before jumping to the conclusion that more long-term care beds are necessary, other options should be explored, such as the creation of more supportive housing, Chan said.

Despite Ontario’s fiscal challenges, big change can still be achieved, Chan argued.

“There are now too many examples of poor quality care that also result in increased costs to the system and we have to absolutely start attacking those problems aggressively,” he said.

As an example, he pointed out that one in five patients with congestive heart failure or chronic obstructive pulmonary disease, is readmitted to hospital within a month of discharge, indicating that health care was inadequate somewhere along the line.

Too many diabetics are not having their eyes and feet regularly monitored and go on to develop vision problems or foot wounds that sometimes lead to amputation.

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Strong leadership is key to achieving necessary change, Chan said.

He notes that the report is filled with evidence-based ideas on how to achieve change. It includes examples of successes that health-care organizations have experienced with new innovations.

“With the release of this year’s (report), we have one key question that we would like CEOs and boards around the province to ask themselves — if someone else has figured out a better way of delivering care, why can’t I do the same?”