Thursday, April 07, 2005

Waits still longer for most surgery, future still vague

VICTORIA - I guess it's good news that the government has discovered that 11,000 of the 80,000 names on surgical waiting lists shouldn't be there.
At least the problem has been identified, and is apparently being fixed.
But that's the extent of the good news, and there's much that's discouraging in the discovery, and in the fact that waits for many procedures are still up over the last four years.
The number of names on a wait list shouldn't matter much. Most of us care about how long it takes for us to get the procedure done, not how many others are on the list with us.
But wait lists matter to people who manage the system. If the list for one procedure keeps growing, then managers devote more resources to the treatment. And if the decisions are based on bad information, then money may be misspent.
The health ministry says it's identified the problem, and will have a new wait list system within the next year that will offer patients and managers accurate information. But it's 2005, long into an era when health care and waiting lists are supposed to be a priority, and basic management information isn't available. (A situation that is true across Canada.)
The news is also gloomy on the wait time front.
Deputy health minister Penny Ballem stresses the progress in providing treatment. The system provided 33 per cent more knee replacements in 2003-4 than it did three years earlier, and 41 per cent more angioplasties.
But the system has not kept up with demand.
The latest data shows that median waits have increased for 11 types of non-emergency surgery since the election, and fallen for five procedures. The wait for cardiac surgery has been cut by about four weeks, to two months.
But other waits have increased substantially. People are waiting one-third longer for knee replacements, with the media wait now 28 weeks. Since the median wait measures the time it takes for half the people to get surgery, that means that many are waiting much longer. The median wait for hip replacements has increased by a month, to almost 22 weeks. Both waits are shorter than in Ontario, acording to a new review; both are much longer than the standard recommended by the Canadian Orthopaedic Association.)
Lots of factors have driven the increased demand. The most significant, Ballem says, is an increase in the rate at which most procedures are being performed. Surgeries hurt less, require less rehab time and provide more consistently successful results. More people are candidates. In 1990, about 1,300 people had knee replacement surgery in B.C.; the annual number is almost three times that today.
The procedures work, so people in pain or with other problems expect treatment.
And since we are not paying for enough surgeries to meet the need, waiting lists grow. In the long term, we can find ways to keep people healthier and reduce demand, and increase efficiency. But now, either governments provide more money or waits increase.
That decision deserves much more open public debate, starting with a clear statement of how long it's reasonable for people to wait for different types of treatment, based on the severity of their condition and the impact on their overall health and lives.
The Wait Time Alliance of Canada, a doctors' group, has just released its proposals. Health Canada is supposed to have a list of acceptable wait times by the end of this year as part of the last health accord signed with the provinces.
We are fumbling with the issue of wait times, with too little information - as the wait list problems showed - and too little honesty.
People need to know what their governments are prepared to deliver, and at what cost.
Only then can they decide if that is enough to meet patients' needs.
Footnote: The model that has worked in at least some other jurisdictions is wait guarantees - knee replacement for moderate case within nine months, for example, of the government pays for surgery outside the system. The process forces an open, honest debate on what we are prepared to promise, and pay for.

No comments: