Canada should heed the lessons of Saskatchewan’s success with reducing surgical wait times, writes Janice MacKinnon.
MacKinnon is interviewed in part three of MLI’s Medicare’s Midlife Crisis series of videos.
By Janice MacKinnon, May 2, 2016
The 2014 Commonwealth Fund Survey, which ranked Canada last in timeliness of care, was one of many studies highlighting the country’s dismal record on health-care wait times. As wait times increased in the 1990s and evidence mounted about their adverse effects on patients, governments were slow to respond, in part because the health-care system was dominated by providers, rather than focusing on patients.
Pressure to address wait times came from the Supreme Court of Canada’s 2005 decision in the Chaoulli case, which focused on the right to timely treatment, from patient accounts of suffering while waiting for care, and the Fraser Institute’s annualsurvey of physicians across Canada, which highlighted how wait times for elective surgeries were longer than clinically reasonable.
The institute’s study also showed that Saskatchewan had some of the longest wait times in the country in the late 1990s and throughout the 2000s. In 2010, the Saskatchewan government made the bold promise that by 2014 no patient would wait more than three months for elective surgery as part of its wait-time reduction strategy, the Saskatchewan Surgical Initiative (SSI).
The SSI changed how waiting lists were managed: they were centralized, patients prioritized and referrals pooled so that patients could use the Internet to choose their physician, armed with the knowledge about the length of their wait for treatment.
The initiative also fundamentally changed the culture and decision-making process in health care. The 2015 Health Canada report on health-care innovation cited three factors that drive innovation and all were central to the SSI.
One was leadership, provided by the bold target set by the government. Another was an inclusive collaborative decision-making process that helped gain the support of key stakeholders. The third was a patient-centred focus, which involved including patients in decision-making and better integrating the system.
Effective communications also helped sell the SSI’s most controversial policy: the use of private, for-profit clinics to deliver day-surgery procedures covered by Medicare. The government was transparent about the selection process for the companies that would run the clinics and the standards they had to meet. Also, government communications focused on the patients and their right to timely care rather than on the significant savings achieved. Most important, however, was the message that the clinics would reduce wait times. People were prepared to set aside ideology and judge the clinics on their results.
In March 2014, the government declared victory when it announced a 75 per cent reduction since 2010 in patients waiting more than three months for surgery. In 2015, the Fraser Institute survey showed that Saskatchewan had the shortest waiting lists (GP referral to treatment) for elective surgery in Canada.
Long waits remain in other areas, and capacity had to be increased, which meant more money for an already expensive health-care system. Also, the SSI did not tackle what international studies cite as a major cause of Canada’s long waiting lists: the structure and funding of Medicare.
Thus, the SSI treated the symptom — the waiting lists — rather than the root problem. But it was not designed to fix Medicare. Its goal was to relieve the suffering of patients who were waiting far too long for surgery. It succeeded.
Dr. Janice MacKinnon is a former Saskatchewan NDP finance minister and current professor of fiscal policy at the University of Saskatchewan School of Public Health.