ICES landmark report identifies how long Ontarians are waiting for key health services

A landmark report, released today by the Institute for Clinical Evaluative Sciences (ICES), identifies the volume and the associated wait times for key health services defined in the Ontario government’s Wait Times Strategy. For the first time, patients, providers, and policy-makers in Ontario now know how long the wait time is in their local areas, and in other parts of the province, for cancer and cataract surgeries, cardiac procedures, and hip and knee replacements. The report also examines the volume of CT and MRI scans performed in different areas of the province.

The findings of the ICES Atlas, Access to Health Services in Ontario, show that over the past decade there have been substantial increases in the number of procedures for each of the services examined, yet many patients continue to experience prolonged waits because demand for services has risen as fast or faster than the increase in supply.

OVERVIEW OF REPORT FINDINGS 

Total hip replacements (THR) and total knee replacements (TKR)

• Between 1993/94 and 2003/04, the annual number of THRs and TKRs performed grew by more than 50% and 100%, respectively. Despite this increase in volume, over the last decade there has been a more than 4-fold increase in the number of people waiting beyond the RMWT benchmark of 26 weeks (6 months) used in other jurisdictions, from about 2,400 in 1993/94 to about 10,400 in 2003/04.
• In 2003/04, median wait times were 24 weeks for THRs and 33 weeks for TKRs. On average, fewer than 50% of Ontarians received their scheduled joint replacement within the 6-month RMWT benchmark recommended elsewhere.
• There is significant variation in wait times across the province for these procedures, with wait times ranging from 16 to 36 weeks for THR and from 26 to 45 weeks for TKR.

Cataract surgery

• The number of cataract surgeries in Ontario more than doubled between 1994 and 2004, from 49,489 to 102,182.
• The median wait time for cataract surgery in 2003/04 was 15 weeks, with almost 50% of individuals waiting longer than the RMWT of 16 weeks (4 months) used in other jurisdictions.
• Wait times across Ontario for this procedure ranged from 8 to 22 weeks.

MRI and CT scans

• Over the last decade, the number of CT scans performed in Ontario increased 3-fold, while the number of MRI scans increased 6-fold. During the same period, the number of CT and MRI scanners operating in Ontario increased by approximately 3-fold and 5-fold, respectively.
• CT scans of the abdomen/pelvis and thorax increased the most during the last decade, by 466% and 403%, respectively. MRI scans of the extremities and spine increased the most during the last decade, by 1057% and 666%, respectively.
• Information about when CT and MRI scans are requested is not routinely collected in Ontario, so it is not possible to determine the average wait time for these tests.

Cancer surgery

• Among the procedures studied (large bowel resection, mastectomy, radical prostatectomy, and hysterectomy) the number of surgeries performed in Ontario increased by 50% since 1994. The largest increase occurred with radical prostatectomy (171%) and the smallest with mastectomy (22%) and hysterectomy (21%).
• In 2003/04, median wait times were 26 days for large bowel resection, 29 days for mastectomy, 46 days for hysterectomy, and 87 days for radical prostatectomy.
• Median wait times varied substantially across regions, with some having consistently longer or shorter wait times for a given surgery, but none having overall longer or shorter wait times.

Cardiac procedures

• In the past decade, there has been a marked increase in the rates of coronary angiography and angioplasty (2.2-fold and 3.6-fold increases, respectively), while the rates of bypass surgery have not increased to the same degree and have actually fallen by 8% in the past three years.
• The median waiting time in 2003/04 was 6 days for angiography, 3 days for angioplasty, and 12 days for bypass surgery. Overall, 56% of patients received angiography and 72% received bypass surgery within the RMWT established by the Cardiac Care Network (CCN) of Ontario. Thus far, CCN has not established an RMWT for angioplasty.
• Variation in procedure wait times across the province, by urgency category, varied significantly with some regions having wait times that were three-times higher than those of other regions for urgent cases.

“While there is no question that many Ontarians are waiting too long for some services, a degree of waiting exists in most health systems, and reasonable wait times should not be equated with poor quality of care,” said Dr. Andreas Laupacis, president and CEO, ICES. “That’s why the baseline information on wait times in this ICES report is so important – we need to know how long people are waiting now. The work of the Ontario Wait Time Strategy Expert Panels in defining recommended maximum wait time (RMWT) benchmarks for Ontario will be the next critical piece of the puzzle.”

“Solutions for improving access to these health services are complex and will require a combination of additional funding coupled with strategies to better manage waiting lists,” said ICES senior scientist and Atlas editor, Dr. Jack Tu. “This ICES Atlas contains 14 recommendations, including the need for a new electronic provincial wait time registry to capture timely and accurate information that can be used by policy-makers, health system managers and providers to reduce wait times to key services.”

Dr. Alan Hudson, lead, Ontario Wait Times Strategy notes, "the data in the ICES report offers for the first time an accurate look at how long Ontario residents are waiting for these key health services and is proof of the need for the province's wait times plan, which is already underway. This sets a baseline to measure the success of initiatives undertaken in the Wait Time Strategy, and allows the public to hold the government and the health system accountable. We will closely examine this report and use its findings and recommendations along with other advice from our expert panels."

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.

FOR FURTHER INFORMATION, PLEASE CONTACT:

• Julie Argles, ICES
• (416)-480-4780
• Cell – (416) 432-8143