I spent my life teaching actuarial science at a university. As a result, I calculated lots of numbers: averages, expected values, variances. But, they were only numbers. What I didn’t see was the individual human story behind each calculation.
But now that I am the human face within one these distributions, I see it all in a different light. The distribution I am now studying is the wide variability of Canadian healthcare delivery relevant to hip replacements.
Some background: I entered the official hip replacement list in Victoria, BC, on July 23, 2014. I was told to expect a wait time of 12 to 18 months. But was that good or bad? Was it necessary? I investigated.
Data show that for hip replacements, British Columbia has the second longest wait times in Canada with a median value of 70 weeks. But that is a median value, which means about half of all patients wait longer. That is twice the wait time in Ontario, which is actually the third best province in Canada, according to Canadian Institute for Health Information (CIHI) statistics.
So, I waited and the hip deteriorated until painkillers seemed useless.
Finally, I got a call to say that my hip surgery was scheduled for week 51 of my wait. I fought back tears of relief. It almost made me forget the absence of a vital life during the weeks I had waited.
What happened next knocked the wind out of my sails.
One week before my scheduled operation I was told that I had been bumped for a situation that presented a “higher level of urgency.” They had just added almost eight weeks to my wait time for reasons that were opaque, at best, and without logic to me. Why did this happen? In the end, I got no real answers, only rumours about parental leave (nothing sudden or unforeseen about that) and other factors that may or may not have been part of the equation.
So, beyond my personal experience, the real question is: “Are Canadian wait times for hip replacement justified or could they be shortened?”
Turns out, the variability within Canada’s health care system is wide, and does not just exist across provincial borders. In most provinces, wait times vary significantly from city to city, region to region, hospital to hospital and doctor to doctor.
The evidence tells us that having a “private” alternative actually makes wait times in publicly-funded healthcare facilities worse. So that is not the solution.
One of the problems in answering this question is a lack of province-wide databases in many jurisdictions. Such databases would help minimize wait times because patients from a busy facility in one region within a province could be transferred to other facilities (or surgeons) with shorter waiting lists.
Today, in most provinces, doctors and specialists work in silos and there is no real overarching management of the system.
Healthcare decision-making in Canada is largely decentralized with few standardized measures of “success.” One doctor can have wait times measurably better or worse than the next and the system cannot be expected to respond well by moving individual patients. The only real leverage many provincial ministries impose is to incentivize desired behaviour through macro-budgets.
We need more integrated management and measurement in the system — if not country-wide, then at least province-wide.
Alberta is a good model. Most recent data show that providing incentives tied to provincial benchmarks based on a standardized care path has created savings of almost 12,600 hospital bed-days (and $13 million) annually. The incentive? The non-monetary savings in resources are pumped back into hip and knee replacement services where the medical teams see the impact of their success first-hand, rather than disappearing back into the system as a whole.
Alberta now meets CIHI benchmarks for hip replacements 87 percent of the time versus a 67 percent success rate in BC. In fact, for 90 percent of its hip replacement patients, Alberta now meets maximum wait-time limit criterion of 14 weeks. Note that providing financial compensation is not necessarily the primary motivating factor.
Canadians consistently show strong support for their health care system. However, wait times continue to drag the outcomes down. We can shorten wait times, but it will take political courage. Let’s hope that courage can be found.
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This article of yours is old wait times 70 weeks ??? 4 years now and counting it hurts everyday 365 days a year and what makes it worse is delinquents see vulnerable people they take advantage of that from…. insults threats and vandalism OH FUCKING CANADA and I say that because the RCMP participate .
i am getting a THR this coming Tuesday 10/15/2019 after waiting since MARCH 2018 (yes 2018) !
I had my first medical visit in March 2018, an X’ray in April 2018, an MRI in October 2018, another MRI in April 2019, a surgeon visit in June 2019 and a pre-op hospital visit in September 2019.
I went from being able to walk miles with my dog, to using a cane around the block, to limping with a walker near my yard, to being almost unable to move.! Pain-free sleep is almost impossible, constipation from pain pills a daily condition and mental attitude was a total disaster.! I am 5’7″- 155 Lbs- excellent general condition and beat prostate cancer 20 years ago.! Canada Health and BC MSP made a cripple out of me and stole years of great living .
And I am only 80 years old, but had to waste what little time i have left because of lack of facilities, physicians, nurses or FUNDS..!
In this electioneering period, you can be sure that I will be FIRST in line to vote for another quick-talking politico..!! yeah..!
How can privately funded clinics make wait times worse. If a private clinic can do 1000 hip replacements a year doesn’t that take 1000 surgeries out of the public system thereby reducing wait times. An example is the Duval clinic in Quebec.
You have the same health care providers working in both systems; your essentially taking the same queue and splitting in two, one queue private and one queue public. It will be a shorter wait time for people that can pay no doubt but longer for those that can’t (public). The only way that wait times could be shorter in parallel private/public system, that is shorter wait times both the public and private, not on average, is if they perform more surgeries over all. And there’s no reason why the couldn’t do that in public system now.
Waiting time for a category 3 (non urgent) THR in South Australia is 6 years.National guarantee is stated as 365 days
Waiting time for a category 2 ( semi urgent ) THR in South Australia is 18 months. National guarantee is 90 days.
Waiting times for cataract surgery is 2 years. Similar “elective” surgery have the same sort of wait times.
About 40% of the population have private health insurance,so 60% of the population have to endure these issues.
I thought Australia was a signatory to the Geneva Convention on torture,obviously not when it includes it’s tax paying citizens. Sounds like Canadian public health care is far better than what we pay for.
I live in the NT, I started the process for knee replacement surgery in February of 2017 with a referral from my Family Dr. to get an appointment to see the Specialist. It took 8 months to finally get an apptointment with the specialist, which I got in September 2018.
I then had to have an appointment with the surgery nurse in October 2018.
Finally in November I was approved by anesthesiology and was placed on the waiting list, a total of 10 months to get onto the list.
It is now March 2018 , I have been on the waiting list for 4 and a half months and I understand the list is 8 months to a year long. All this time I have been taking pain medications,had cortisone shots in my knee, did everything I could to help myself and get rid of the pain. I am now in a walker, pretty much housebound unless I get help from family, and the worse part is my hip is now causing discomfort and my family Dr. Says it needs to be replaced. That means I have to start this process all over again which I did by getting a referral to see this same specialist . Which I am already her patient.?
I am 77 years old, 13 months has gone by and I am still waiting .
Our health care system in the North especially for seniors is one of the best in Canada, I just don’t understand the long wait time for surgery when there is no other option to fix the problem. Living in pain is hard on anyone. Being a senior, my quality of life has declined due to pain and lack of mobility. Having to wait this long has worn me down and I am at the point now Of calling it off and resigning myself to living with pain and making the best of it. Just thought I would tell you my story of what waiting has done to my life.
Hi Reta,
I’m a certified yoga therapist & work with older adults who suffer from chronic pain from osteoarthritis or old injuries. My oldest client is 91 years old who was not a candidate for a knee replacement. Pain is really a symptom. The root of the problem is somewhere else in your body. Every body is unique as each person has a unique history.
Yoga therapy is gentle & therapeutic to get to the root cause of your pain. It’s not a regular yoga class. I get very good results. Usually a few sessions pain reduced or gone. Maybe you won’t need surgery.
Every province is a different system but Ontario provides an example of the potential evil in wait list targets. It’s much more insidious than just a bunch of nice people working hard to provide more care….
A given hospital might be expected to do so many joints a year, there’s a bounty of $XYZ per case that is given to the hospital up front at the start of the fiscal year. Administrators go spend it immediately then restrict practice with no beds no OR time so fourth quarter comes up and we’re running behind. Hospital doesn’t have the cash to refund that up-front payment and so surgeons are driven by Admin to work eves and weekends to get the volume done. Often it can mean farming out other care, one hospital recently offloaded almost a hundred hip fractures to make room for joints – and then hired locum surgeons with little training or experience to do the work. Then Joe Public wonders why his or her joint is loose and infected – but nobody sees that, surgeon outcomes are not tracked nor monetized as they should be.
We found that the chance of achieving a better than expected postoperative functional outcome decreased by 8% for each month on the waiting list for hip replacement. Expedited access resulted in a larger proportion of patients with better than expected function 12 months after surgery.
Garbuz et al. Delays Worsen Quality of Life Outcome of Primary Total Hip Arthroplasty. Clinical Orthopaedics & Related Research: June 2006 – Volume 447 – Issue – pp 79-84
There is also huge variation between regions within a province. You live on Vancouver Island, the worst region in Canada for knee replacements (only 29% within the target) and second worst for hip (45%) according to 2016 CIHI data. Let’s learn from AB and SK, and improve together…. we cannot rely on political will (courage) only.