Wait Time Alliance Report Card Questions & Answers

Transcription

1 Wait Time Alliance Report Card Questions & Answers 1. Are we improving on wait times in Canada? What is this year s report saying? Unlike the past two years, overall national performance on wait times for four procedures identified in the 2004 Health Accord improved slightly in 2014 with Newfoundland and Labrador, Ontario and Saskatchewan having the best marks. However, as per previous years, this year s report card shows significant variation still exists among some provinces and among regions within provinces. Timely access can be affected by where you live. Overall, patients still wait much too long to receive the care they need. 2. How does Canada compare with other similar countries? There is still a long way to close the gap between wait times in Canada for elective care compared to other leading industrialized countries with universal health systems. While there has been some progress in Canada to reduce wait times, they frequently far exceed those found in many other countries with universal health care systems such as England, Scotland or the Netherlands. Canadians wait longer in hospital emergency departments than citizens of other developed countries. Here are some very revealing figures; 27% of Canadians reported waiting more than four hours in emergency compared to only 1% in the Netherlands and 5% in the U.K. 3. The 2014 Health Accord is over Does this mean the end of the WTA? If not what else needs to be done - what do you prescribe? While there has been considerable effort over the past 10 years toward improving timely access to care for Canadians, much work remains to achieve the levels of performance seen in other countries. 1

2 The largest single commitment of the September 2004 Accord was the $5.5 billion Wait Time Reduction Fund (WTRF), which was intended to reduce waiting times for radiation therapy for cancer, coronary bypass surgery, diagnostic imaging, hip and knee replacement and cataract surgery. While we have not licked the wait time problem for scheduled procedures yet far from it I believe that we have made great strides in these initial areas over the past 10 years. But wait times remain a concern across all specialty areas, and we need to better ensure that money buys sustained change. Some may argue that long waits are the price Canadians must pay for having a universal health care system. We do not see it this way. The focus on wait times is necessary for several reasons. First and foremost, it is not right to force Canadians to wait twice or three times longer for necessary medical care than citizens of other countries which also have universal publicly funded health care systems. Second, as seen in many other countries with universal health systems, it is possible to have timely access to medical care long waits are not an unavoidable price to pay nor are they tolerated by their citizens. Third, there is a significant cost to unnecessary waiting. It begins with a human cost to patients (and their families) whose health often suffers and deteriorates while waiting unnecessarily for care. There is also an economic cost to both the patient/family and to society through lost labour productivity and lost tax revenue. Fourth, long waits hinder strong health system performance. They lead to additional costs such as increased drug spending (e.g., to manage pain) or testing to monitor patients while they wait, as well as medical complications requiring more invasive treatment and follow-up. Finally, long wait times are usually a symptom of poor health system performance or poor coordination between systems (e.g., lack of safe and affordable housing options for seniors) that need to be addressed. 4. How would more money invested in health infrastructure help with wait times? The impact of the lack of suitable living arrangements such as long-term care beds for seniors and other patients who are waiting in acute care beds ripples throughout the entire health system, causing surgical backlogs and crowded emergency rooms. Today, hospital care costs approximately $846 per day, while long-term care costs $126 and home care $42. The lack of access to 2

3 home care and long-term care represents an added cost of approximately $2.3 billion to the health care system. A health care infrastructure plan could go a long way to help patients remain in their communities and get better care, while making better use of limited health care resources. Improving the timeliness of patients total journey for care (e.g., time to access a family physician, time to access a referral, time to access home care) is an important goal, but so too is addressing the lack of infrastructure support to provide more alternate levels of care for the high number of elderly patients. Many of these elderly patients have dementia and several chronic conditions and are waiting in acute care beds for more suitable placements. Better management of patients with complex care needs through integrated community-based collaborative care models is also required. 5. What is the position of the Wait Time Alliance on the private delivery of health care issue? The WTA continues to support the principle that access should be based on need and not the ability to pay and supports wholeheartedly a universal health care system. The WTA is not advocating for the privatization of Canada s health care system. The system needs to be shored up to ensure that it s sustainable and provides timely access to quality care beyond the five politically selected treatment areas. 6. How would you remedy the long wait time situation? What would you recommend? The WTA offers five recommendations to help address current challenges including: implementing a charter on right and responsibilities that would include access targets and enforceable wait-time guarantees; developing a pan-canadian seniors care strategy to help address the high numbers of seniors patients who are waiting in acute care beds for more appropriate placements; making better use of existing surgical infrastructure (both physical and human resources); and the need for all stakeholders to identify ways in which to improve the collection, reporting and use of wait-time data across the full continuum of care that benefits all. As found with other leading countries, 3

4 the federal government should be involved in supporting a national approach to improving timely access for all Canadians. There is an urgent need to develop alternate level of care options for patients who are occupying acute care beds; this is a major bottleneck in the health care system. To address the issues of: (1) increased numbers of ALC patients, many of whom have dementia and other chronic conditions, and (2) the lack of appropriate residential and community based options for seniors, the federal and provincial/territorial governments should collaborate with stakeholders in developing a pan-canadian (national) Seniors Strategy. 7. Most of provincial governments have had and will have austerity budgets in the coming year. Can governments afford to tackle wait times? Not only are patients experiencing more pain and suffering while waiting but excessive waits also mean loss of government revenues and loss of employment income due to excessive waiting for health care it s all about productivity. We cannot afford not to tackle wait times. Long waits for health care are bad for patients and bad for the economy. Canadians expect high quality care and improvements can be made even in challenging economic times. Many of the changes can be made by improving patient flow without significant additional cost (e.g., ALC patients, better appropriateness screening to determine eligibility for treatment and better use of health human resources). 8. What can be done to improve the collection of wait-time data? Clarifying and standardizing wait-time definitions/criteria among provinces is critical to improving collection of data. We need to standardize the reporting of wait times so that the data are comparable. Many provinces do not separate out the wait times according by urgency category (i.e., emergency, urgent and elective).this distorts the actual wait times patients experience. 4

5 We also need to expand the collection and reporting of access to a wider range of specialty care services. 9. Tell us about Scotland. What have they done that is so compelling? Scotland has made great strides in improving timely access to care for its citizens. Wait time standards are part of an overarching Scottish National Health Service strategy for quality. Wait Times are managed as one of the six dimensions of quality (Patient-centred, equitable, effective, efficient, safe, and timely). Scotland introduced an 18 Weeks Service Redesign and Transformation Program in 2010 (18 weeks from receipt of a GP referral up to the point at which each patient is actually admitted to hospital for treatment including diagnostic testing). The program developed 'Five Key Changes' to support the service transformation required to achieve the 18 Weeks RTT Standard: o Improve referral and diagnostic pathways o Treat day surgery as the norm o Actively manage admissions to hospital o Actively manage discharge and length of stay o Actively manage follow ups In addition, Scotland had strong political leadership and solid information management systems to support their improvements. It introduced a Patients Rights Act in 2011 and a Charter of Patient Rights and Responsibilities in 2012 that refers to a 12 weeks treatment time guarantee (TTG) for planned inpatient or day-case treatment from decision to treat. Today, over 90% of patients requiring elective care in Scotland are treated within 18 weeks (from GP referral to treatment), over 98% of inpatient procedures and day surgery cases are treated within 12 weeks of agreement to treat, and over 90% of patients are seen within four hours in the emergency department (i.e., admitted, transferred or discharged). 5