Fraser Institute says hospital waiting times longer, over 800,000 patients waiting for treatment

Contact:

Michael Walker, Executive Director
The Fraser Institute
Tel. (403) 216-7175 or (403) 220-5764
Email: michaelw@fraserinstitute.ca

Release date: 25 September 2001

VANCOUVER, BC— Despite a massive infusion of federal spending on health care, waiting lists have grown significantly. Total waiting time for patients between referral from a general practitioner and treatment, averaged across all 12 specialties and 10 provinces surveyed, rose from 13.1 weeks in 1999 to 16.2 weeks in 2000-01 (a 23.7 percent increase), according to The Fraser Institute's 11th annual survey, Waiting Your Turn: Hospital Waiting Lists in Canada

"Canada-wide total waiting time increased significantly in 2000-01—and its level is high, both historically and internationally. Compared to 1993, waiting time in 2000-01 is 69 percent higher. Moreover, academic studies of waiting time have found that Canadians wait longer than Americans and Germans for cardiac care, although not as long as New Zealanders or the British," says Michael Walker, Executive Director of the Fraser Institute.

Total waiting time

This nationwide deterioration reflects waiting-time increases in eight provinces, while concealing decreases in waiting time in Saskatchewan and Newfoundland.

Among the provinces (Chart 1), Ontario achieved the shortest total wait in 2000-01, 13.9 weeks, with Newfoundland (14.6 weeks) and Prince Edward Island (15.0 weeks) next shortest. Despite a significant improvement, Saskatchewan exhibited the longest total wait, 28.9 weeks. The next longest waits were found in New Brunswick (25.8 weeks) and British Columbia (18.9 weeks).

Chart 1: Median wait by Province in 2000-01: Weeks waited from referral by GP to treatment

Source: The Fraser Institute, annual waiting list survey, 2001.
Note: The sum of the weeks in the charts may not exactly match the numbers stated in the text due to rounding.

The first wait: Between general practitioner and specialist consultation

The rise in waiting time between 1999 and 2000-01 is principally a result of an increase in the first component of total waiting time-the time between GP referral and specialist consultation. This component of waiting time increased from 4.9 weeks in 1999 to 7.2 weeks in 2000/1, an increase of 46.9 percent (Chart 2).

Chart 2: Waiting by Province in 1999 and 2000-01: Weeks waited from referral by GP to appointment with specialist

Note: Survey was taken during doctor office closures which were due to a compensation dispute.
Source: The Fraser Institute, annual waiting list survey, 2000 and 2001.
Note: The sum of the weeks in the charts may not exactly match the numbers stated in the text due to rounding.

The shortest waits for specialist consultations were experienced in Prince Edward Island (6.3 weeks), Saskatchewan (6.3 weeks), and British Columbia (6.5 weeks). The longest waits for specialist consultations occurred in New Brunswick (16.2 weeks), Nova Scotia (8.8 weeks), and Alberta (7.9 weeks).

The second wait: Between specialist consultation and treatment

Waiting time between specialist consultation and treatment-the second stage of waiting-increased for Canada as a whole between 1999 and 2000-01, rising from 8.2 to 9.0 weeks, an increase of 9.8 percent (Chart 3). Significant decreases in Saskatchewan, Newfoundland and Prince Edward Island disguise increases in the other seven provinces.

Chart 3: Waiting by Province in 1999 and 2000-01: Weeks waited from appointment with specialist to treatment

Source: The Fraser Institute, annual waiting list survey, 2001.
Note: The sum of the weeks in the charts may not exactly match the numbers stated in the text due to rounding.

The shortest specialist-to-treatment waits were found in Ontario (7.0 weeks), Nova Scotia (7.8 weeks), and Newfoundland (8 weeks), while the longest such waits existed in Saskatchewan (22.6 weeks), British Columbia (12.3 weeks), and New Brunswick (9.6 weeks).

Numbers of people waiting

Throughout Canada, the total number of people estimated to be waiting for treatment was 878,088 in 2000-01, an increase of 3 percent between 1999 and 2000-01. The number of people waiting rose in New Brunswick, Alberta, British Columbia, Manitoba, and Ontario. As a percentage of the population, 2.8 percent of Canadians were waiting for treatment in 2000-01, which varied from a low of 1.8 percent in Prince Edward Island to a high of 7.2 percent in Saskatchewan.

The survey also asked physicians what percentage of their patients received non-emergency medical treatment outside of Canada (Table 1). The highest percentage of patients seeking treatment outside of Canada were those in need of radiation oncology (5.6 percent). For all specialties, 1.7 percent of patients left the country to receive treatment.

Table 1: Average Percentage of Patients Receiving Treatment Outside of Canada, 2000-01

Waiting by specialty

Chart 4: Median wait by specialty in 2000-01: Weeks waited from referral by GP to treatment

Source: The Fraser Institute, annual waiting list survey, 2001.
Note: The sum of the weeks in the charts may not exactly match the numbers stated in the text due to rounding.

There was a striking increase between 1999 and 2000-01 in the wait for ophthalmology (+8.9 weeks), and neurosurgery (+4.5 weeks). These increases mask improvements for patients receiving treatment in otolaryngology (-4.2 weeks), urology (-1.1 weeks), gynaecology (-0.8 weeks), orthopaedic surgery (-0.6 weeks), and radiation oncology (-0.1 weeks). The wait for general surgery remained the same.

Breaking waiting time down into its two components, there is also variation among specialties. With regard to GP-to-specialist waiting, the shortest waits are found in medical oncology (3 weeks), radiation oncology (3.1 weeks), and general surgery (3.6 weeks), while the longest waits are for neurosurgery (13.8 weeks), ophthalmology (11.6 weeks), and orthopaedic surgery (11.4 weeks).

For specialist-to-treatment waiting, patients wait the shortest intervals for medical oncology (2 weeks), urgent cardiovascular surgery (2.8 weeks), and urology (4.7 weeks), and wait longest for ophthalmology (16.3 weeks), orthopaedic surgery (15 weeks), and plastic surgery (13.7 weeks).

"Reasonable" and actual waiting times compared

In addition to actual waiting times for care, specialists are also surveyed as to what they regard as clinically "reasonable" waiting times (Chart 5). In 86 percent of the 121 categories surveyed (some comparisons were precluded by unavailable data), actual waiting time exceeded reasonable waiting time.

Chart 5: Median actual wait versus median clinically reasonable wait by specialty for Canada: Weeks waited from appointment with specialist to treatment in 2000-01

Source: The Fraser Institute, annual waiting list survey, 2001.
Note: The sum of the weeks in the charts may not exactly match the numbers stated in the text due to rounding.

Averaged across all specialties, Nova Scotia and New Brunswick came closest to meeting the standard of "reasonable" in that their actual specialist-to-treatment waits only exceeded the corresponding "reasonable" values by 49 and 64 percent, respectively, smaller gaps than in the other provinces.

"This partially reflects higher standards as to what is 'reasonable' in a number of other provinces, such as Ontario, and Quebec. Among the specialties, 'reasonable' was most often met or bettered for medical oncology and urgent cardiovascular surgery," notes Walker.

Waiting for diagnostic and therapeutic technology

The growing waits to see a specialist and to receive treatment were not the only delays facing patients in 2000-01. Patients also experienced significant waiting times for various diagnostic technologies across Canada (Chart 6): computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound scans, although the median waits for all three technologies remained the same as in the Institute's 1999 survey. The median wait across Canada for a CT scan was 5.0 weeks.

Chart 6: Waiting for technology: Weeks waited to receive selected diagnostic tests in 1999 and 2000-01

Province	Computed Tomography		Magnetic Resonance Imaging		Ultrasound
	2000-01	1999	2000-01	1999	2000-01	1999
British Columbia	6.0	6.0	14.0	16.0	2.5	2.0
Alberta	6.0	7.0	12.0	18.0	2.5	3.0
Saskatchewan	8.0	7.0	16.0	13.5	2.0	1.5
Manitoba	5.0	5.3	8.0	8.0	8.0	7.0
Ontario	5.0	4.0	12.0	12.0	2.0	2.0
Quebec	4.0	4.0	12.0	12.0	4.0	4.0
New Brunswick	4.0	3.0	10.0	9.0	4.0	4.0
Nova Scotia	3.5	3.5	13.0	10.0	3.0	2.5
Prince Edward Island	10.3	8.0	12.0	14.0	6.0	4.8
Newfoundland	6.0	6.0	23.0	17.0	5.5	5.5
Canada	5.0	5.0	12.0	12.0	2.5	2.5

Source: The Fraser Institute, annual waiting list survey, 2000 and 2001.
Note: The sum of the weeks in the charts may not exactly match the numbers stated in the text due to rounding.

The shortest wait for computed tomography was in Nova Scotia (3.5 weeks), while the longest wait occurred in Prince Edward Island (10.3 weeks). The median wait for an MRI across Canada was 12 weeks. Patients in Manitoba experienced the shortest wait for an MRI (8.0 weeks), while Newfoundland residents waited longest (23.0 weeks). Finally, the median wait for ultrasound was 2.5 weeks across Canada. Saskatchewan displayed the shortest wait for ultrasound (2.0 weeks), while Manitoba exhibited the longest ultrasound waiting time, 8.0 weeks.

Waiting Your Turn

The Fraser Institute's annual Waiting Your Turn survey presents the only comprehensive measure of hospital waiting times across Canada. The survey measures the extent to which queues for visits to specialists and for diagnostic and surgical procedures reflect health care rationing in the provinces. Information for the survey was provided by 2,518 specialists nation-wide during the latter part of 2000/2001.

The extent of Canada's health system dysfunction was also documented in a 2000 Fraser Institute study Spend More, Wait Less? examining the impact of increases in government health spending. This analysis revealed that provinces spending more on health care per person had neither shorter (nor longer) total waiting times than those spending less. In addition, those provinces spending more had no higher rates of surgical specialist services (consultations plus procedures) and had lower rates of procedures and major surgeries.

"This grim portrait is the legacy of a medical system offering low expectations cloaked in lofty rhetoric. Indeed, under the current regime-first-dollar coverage with use limited by waiting, and crucial medical resources priced and allocated by governments-prospects for improvement are dim. Only substantial reform of that regime is likely to alleviate the medical system's most curable disease-longer and longer waiting times for medical treatment," says Michael Walker, Executive Director of The Fraser Institute.

Note on the Methodology

The provincial and national weighted medians reported in Waiting your Turn, 10th edition have been restated for ease of comparison with previous years.

The number of patients waiting for treatment is much larger than reported in previous years due to more comprehensive data, including the addition of acute inpatients and same-day surgery discharges.

Established in 1974, The Fraser Institute is an independent public policy organization based in Vancouver with offices in Calgary and Toronto.

contact:
Suzanne Walters, Director of Communications, The Fraser Institute, (604) 714-4582,
Email: suzannew@fraserinstitute.ca.