Surgical wait times not improving

Wait times for priority medical treatments like hip and knee replacements are not going down despite concerted efforts in all provinces to improve the situation, a new report shows.

Tuesday's report from the Canadian Institute for Health Information showed that despite performing almost 21,000 more procedures in 2012 compared with 2011 — a record — the overall length of time that patients waited did not fall accordingly.

The five priority areas from the 2004 plan that provinces and the federal government agreed to concentrate on were:

• Radiation therapy for cancer.
• Cardiac bypass surgery.
• Hip and knee replacements.
• Hip fracture repair.
• Cataract surgery.

"Initially we saw wait times drop dramatically," Kathleen Morris, director of health system analysis at CIHI, said in an interview. "What we're seeing now is that the wait times aren't improving."

Demand for hip and knee replacements is rising at a rate that outpaces the ability of health systems to keep up. The number of joint replacements in 2012 was 15 per cent higher than in 2010 but despite the higher volume and spending, the proportion of procedures that were carried out within the recommended time — 182 days — went down four percentage points from 84 per cent to 80 per cent for hips and from 79 per cent to 75 per cent for knees.

Morris pointed to three possible factors for the increasing demand for joint replacements:

• Aging population.
• Growth in health conditions such as obesity and arthritis that drive the need for hip and knee replacements.
• Technical improvements to the prostheses themselves, which now last longer and are now increasingly being offered to younger patients aged 45 to 54.

"We have good information on number of surgeries, we have good info on how long patients wait but what we don't really know across the country is whether a patient actually feels better after the surgery compared to before. So do they have less pain, are they more mobile? There isn't good information Canada-wide on that," Morris said.

The provinces lagging furthest behind were Manitoba, Nova Scotia and P.E.I.  In contrast, in Newfoundland and Labrador, hospitals boosted funding for more joint replacement surgeries in 2012. Alberta also increased the number of patients treated by shortening the hospital stays for patients after surgery from five days to four.

The increase in hip and knee replacements cost provincial health care systems more than $100 million between 2010 and 2012.

"Despite this plateauing of progress in reaching the benchmarks, more than 538,000 Canadians received priority surgical procedures in 2012," the report's authors said.

As the 10-year wait times strategy nears its end in 2014, radiation therapy was the one bright spot — the only area that surpassed the 90 per cent target. About 97 per cent of people with cancer needing radiation received the care within the recommended 28-day period.

Last year, a report from the Wait Time Alliance, which includes the Canadian Medical Association and specialists, also noted an overall trend to longer waits.

The 10-year Health Accord with its annual six per cent escalator in annual funding ends in 2014.