No Wait Time Standards

October 20, 2005

No Wait Time Standards

We are one year into the Martin government's "ten year plan to strengthen health care" and the wheels are already coming off the cart. In September 2004 First Ministers agreed to provide "meaningful information" including: "Evidence-based benchmarks for medically acceptable wait times starting with cancer, heart, diagnostic imaging procedures, joint replacements, and sight restoration will be established by December 31, 2005 through a process to be developed by Federal, Provincial and Territorial Ministers of Health."

In May 2005 the Canadian Institutes of Health Research announced funding of eight applications to research evidenced-based benchmarks for medically acceptable wait times. According to news reports provincial officials say there is no way they can keep their commitment to develop evidenced-based benchmarks by December 31st. BC's Health Minister, George Abbott, was quoted on Canada.com saying: "For the present time there are probably only a few areas in which one might be able to move forward by evidence-based benchmarks."

Ontario took the challenge to reduce wait times seriously. It commissioned the Institute for Clinical Evaluative Studies (ICES) to identify the wait times for key indicators identified in Ontario's Wait Times Strategy. The Institute's researchers prepared a comprehensive report that quantified wait times for key services by region of the province. They observed:

"Randomized clinical trials of different wait times are difficult to conduct and observational studies of waiting lists will have limitations due to selection biases in determining which patients undergo surgery first. Development of benchmarks for the five key services will have to rely primarily on consensus opinions of expert clinicians and patients, guided by the limited available scientific literature on this topic. Given that the clinical course of patients on waiting lists will never be predictable with a high degree of certainty, it may be perfectly reasonable that different provinces in Canada choose different benchmarks that reflect local values and resources. Ontario benchmarks for the key services should build upon work already conducted on this topic by groups such as the Western Canada Waiting List Project, the Canadian Medical Association, and benchmarks used in other Organization for Economic Cooperation and Development (OECD) countries. Countries such as England, Sweden, New Zealand, and Spain have developed national wait time benchmarks and have found these to be effective in stimulating and improving their respective health care systems."

Ontario's willingness to use benchmarks based on expert advice and "local values and resources" when evidence is lacking for scientifically based benchmarks stands in sharp contrast to remarks attributed to BC's Health Minister. According to the Canada.com story, "British Columbia has no intention of setting non-scientific access targets"; Abbott said: "Artificially or otherwise contriving benchmarks that had no robust medical evidence behind them would not be a useful advance on what we already have."

Abbott needs to clarify his position on the province's commitment to wait list benchmarks. He will no doubt be given that opportunity when his budget estimates are called for legislative debate in the next few weeks. Cynics believe that the province will not commit to wait list benchmarks, whether by December 31, 20005 or any other date, because that would open the province to legal action such as occurred in Quebec in the case of Chaoulli v. Quebec. The courts are going to further rule on the matter of unsatisfactory, and sometimes unsafe, waits for health care whether the provinces adopt standards or not. British Columbia would be far better served by a Minister of Health who was willing to accept expert advice and set standards based on that advice, as well as on local values and resources.