The Fix – Canadian Healthcare Wait Times Crisis

Ten years ago, I was frustrated with the government failed attempts to fix our healthcare wait times.  Fast forward to today, wait times are no better.  In fact, reports suggest we are worse off.

In March, Fraser Institute reported Canadians lose $2.1 billion in wages due to long waits for surgery and medical treatment, The Private Cost of Public Queues for Medically Necessary Care, 2019.  Canadian corporations, organizations and tax payers pay for most of it.

In 2009, I started Medical Confidence. Our focus was to solve the biggest causes of delayed healthcare access.  I am proud to say that our work with patients, employers, insurers and doctors saves patients an average of 220 days in their wait time from referral to treatment. Ultimately, reducing employers healthcare and benefit costs. Before I get into how we do this – let’s take a closer look at the past attempts and where we are today.

Past Government Attempts to Fix Wait Times

In 2004, Canada’s first ministers agreed to work to reduce wait times. Each premier had their provincial government work with the Canadian Institute for Health Information (CIHI) to improve public wait time reporting. The federal government spent a total of $41.3 billion over 10 years. $5.5 billion was spent to solve joint replacement, coronary artery bypass, cataract surgery, and MRI wait times.

So what happened with all that money we would expect to see some progress.  In fact, Canada has the 5th most expensive healthcare system in the world.  Yet, in the latest Commonwealth Fund report (2017) we ranked second last in the category of access to care and one of the lowest when it comes to performance. In 2018, the Fraser Institute reported wait times increased 136% since their first report in 1993.

Why hasn’t all that money paid off?  I rely on management principles to run my company.  Peter Drucker, probably the most respected person in management principles had 2 important teachings.  First, “You can’t manage what you can’t measure”.  Second, “Management is doing things right; leadership is doing the right things.”.  While our governments got a good start on the first, they fell far short on the second.

The Fix to Wait Times

So how do we reduce patients wait times by 220 days?

Our first step was to truly understand the causes of delays. So what problems did we solve for?

1. Knowing who to refer to:

Canadian patients require a referral to see a specialist.  The majority rely on their general practitioner (GP) to select and refer to the right specialist.  But a 2011 survey by the Canadian Medical Association (CMA) found that only 43% of GPs find the referral system to be efficient. The primary reason so many find the system ineffective is because they could not find an available specialist in the area required who would accept their patient. So why can’t our GPs find us specialists? The reasons include:

• Increased specialization:

Discoveries of new diseases, drugs, procedures, and surgical equipment happen everyday.  As a result, every 5 years these new discoveries double the information doctors need to keep up. That is too much information for any person to reasonably master. So, doctors become more specialized within their area of practice. Today, there are only 67 specialties, sub-specialties and special programs recognized by the Royal College of Surgeons and Physicians. This falls short of the true number of sub-specialization.

• Limited reference resources:

GPs have no detailed directory to search to find the expertise required for their patient. Our GPs are limited to personal relationships or provincial directories.  The provincial directories have very little helpful information about each specialist.  They don’t include the specialist’s practice focus and have no information about when they would accept to see a patient.

In the end, the GP makes multiple referrals and the patient sees multiple specialists. All before finding one who has the skills needed. The result – lost time.

2. Limited information with the specialist referral: 

In another CMA study, specialists complained that they were not provided enough information about the patient.  This includes laboratory tests, x-rays, etc. Far too often, patients find themselves being told in the first appointment that tests such as blood work, MRI, CT-scan or x-rays are needed.  Without them the specialist cannot properly assess, nor provide a diagnosis, nor discuss treatment options.  So, the patient must leave and come back when the tests are completed. The result – more delay.

3. Perceived lack of control:

According to a 2011 Health Council of Canada report only 48% of Canadians with a regular doctor feel engaged in their healthcare. This lack of engagement leads many Canadians to take a backseat role in their healthcare.

“Doctor knows best” or “I have no say; the system dictates what happens to me” are common Canadian feelings. When a specialist needs to be involved in their care, Canadians count on their GP.  They rely on them to know who to refer them to and to get them an appointment.  This often leaves patients feeling powerless in their own healthcare choices.

The current system provides little information to patients and leaves little room for their input. It creates a system where patients do not challenge nor question the services provided.  This often leads to the wrong treatment or patients do not follow the doctor’s treatment plan. This all puts more demands on the healthcare system. The result – more delay.

Then, as Drucker said, it’s about doing the right things. The right thing was to work with all involved: patients, employers, and insurers.  By working together, we have solved each of these delays.  Patients are informed, educated and ultimately access the most optimal care in a timely manner. I am proud to say we have changed the way Canadians access care and improving how our healthcare system works.