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Ubiquitous wrote

A survey by the Fraser Institute found a median wait of 20
weeks for "medically necessary" treatments and procedures in
2016 - the longest-recorded wait time since the think tank
began tracking wait times.

Once again gullible rightists have been sucked in. At least
Trump is saving you from Canadian health care.


Analysis
Fraser Institute's wait-time survey: Does it still count if
most doctors ignored it?
Only around 20% of doctors responded to questionnaire



Fill out this survey and have a chance to win $2,000 — that's
the annual enticement from the Fraser Institute, an offer made
to thousands of doctors whose names appeared on a mailing list.

But it wasn't tempting enough to get doctors to participate.

No medical oncologists in Saskatchewan, Manitoba or New
Brunswick took the bait.

Zero responses came back from radiation oncologists in New
Brunswick or from cardiovascular surgeons in Manitoba.

Not a single plastic surgeon in Prince Edward Island or
Newfoundland answered the questionnaire.

Across Canada, just seven per cent of psychiatrists on the list
bothered to answer the short survey asking them to estimate how
long their patients are waiting for care.

The Fraser Institute is a think-tank that has long advocated
for more private-sector options in the Canadian health-care
system.

Every year for more than two decades it has published a gloomy
report about wait times for health care. This year's came out
on Wednesday.
1 in 5 doctors respond

And every year only around one in five doctors participate,
despite that offer of a $2,000 cash draw. In Ontario, less than
15 per cent of all specialists on the mailing list weighed in
on the issue of wait times.

The survey — just six questions — doesn't ask the busy
specialists to check their patient records or submit any hard
patient data. Doctors are asked only to estimate how long their
patients wait to see them, and then wait for diagnostic tests
and surgeries.

'We would love it if we had more responses.'
- Bacchus Barua, Fraser Institute

"We're absolutely clear about the fact that this is a survey,"
said Bacchus Barua, one of the authors of the report. "This is
not something we can control. We would love it if we had more
responses."

As a way to measure wait times, it's "preposterous," said
Steven Lewis, a health policy consultant based in Saskatoon.
"Why not use a thermometer rather than asking people for their
opinion about the weather?"
'Participation bias' skews results

"Physicians are inundated with surveys, so they pick and
choose," Lewis said. "It's also plausible that the most
frustrated physicians respond, representing the worst of wait-
time experiences."

It's called "participation bias"— a well-established fact in
statistical science that people who take the time to answer a
survey are different than the ones who ignore it.

"Individuals sometimes complete surveys when they are having
particular difficulties with the issue being studied," said
Monique Gignac, a professor at the Dalla Lana School of Public
Health at the University of Toronto. In other words, doctors
who don't think wait times are unreasonable might not be
motivated to fill out the survey.

"Doctors were also asked to mentally average wait times for
what might have been very different conditions and experiences
among their patients," she said. "As a result, the questions
may have introduced a number of biases into the study."

'To inform patients'

For the Fraser Institute, wait times have held a historic
fascination. Its founder, Michael Walker, is cited in this
year's report as the person "responsible for helping navigate
the beginnings of wait-time measurement in Canada."

Back in the late 1980s, Walker was a vocal critic of the
Canadian health-care system.
Bacchus Barua

Bacchus Barua says the Fraser Institute is 'absolutely clear
about the fact that this is a survey.' (Fraser Institute)

"High-income Canadians effectively are prevented from using
their incomes to buy a higher standard of health-care equipment
and service," he wrote in a 1989 report for the Heritage
Foundation, a U.S. conservative think-tank.

Three years later, Walker started releasing the annual Canadian
wait-time surveys. In the 1992 report, he stated that the
Fraser Institute's objective was "the redirection of public
attention to the role of competitive markets in providing for
the well-being of Canadians."

In more recent versions of the report, there is no longer any
discussion of policy alternatives, just the facts — as reported
by a fraction of the country's specialists.

Barua said he only has one agenda: "to inform patients about
wait times in Canada."

However, the 2013 survey has been entered as evidence in a
constitutional challenge against medicare. The plaintiff,
investor-owned Cambie Surgeries Corporation in Vancouver and
its CEO, Dr. Brian Day, aim to change the law to allow private
payment for medically necessary hospital and physician care.
The attorneys general of B.C. and Canada are intervening on
behalf of the Canada Health Act and the B.C. Medicare
Protection Act.

Landmark private health care lawsuit heads to court
Should Canada have a hybrid public-private health care
system?

Health policy analyst Karen Palmer was sitting in on the trial
when one of the Fraser Institute's wait-time study researchers
was called as an expert witness for the private clinic.

Palmer, an adjunct professor at Simon Fraser University, said
the flaws in the reports methodology were exposed under cross-
examination from the lawyers representing the B.C. attorney
general.
Provincial data available

"The Fraser Institute methodology is — and I use the word
carefully — an abomination," Lewis said, adding that there's a
better way: use real data.

"If you tag a referral to the billing code for an office visit,
you can easily calculate the time between seeing the GP and
getting referred, and the visit to the specialist," he said.

'The Fraser Institute methodology is — and I use the word
carefully — an abomination.'
- Steven Lewis, health policy analyst

Barua said the Fraser Institute doesn't have the resources to
do a more detailed survey, and sticking to this format allows
them to compare results with the older surveys.

There is another source of data about wait times in Canada.
Since 2006, the Canadian Institute for Health Information has
used provincial data to track wait times in five priority
areas: cancer, heart surgery, joint replacement, sight
restoration and diagnostic imaging.

The 2016 report, released in March, concluded that: "Wait times
for urgent procedures were at or approaching benchmark
targets."

It found mixed results for some elective procedures, but
overall painted a much brighter wait-time picture for
Canadians.

"Despite this lack of consistent improvement in wait times for
joint replacement and cataract surgery, Canada continues to
perform well on median wait times for these procedures when
compared internationally," the report said.

But what about all of those anecdotes, people everyone knows
who've had horrific waits? Palmer said it's important to take a
close look at those examples.
Karen Palmer

Health policy analyst Karen Palmer is watching the B.C. court
case challenging medicare. She says the Fraser Institute wait-
time report was used as expert evidence to support the fight
for private health care. (Simon Fraser University)

In most cases, Palmer believes there's been a miscommunication.

"There's sometimes a disconnect between the patient's perceived
need and the physician's professional judgment of the
urgency," Palmer said.

Sometimes patients forgot to book appointments, or family
doctors didn't advocate hard enough to get them seen faster.
And Palmer said regional specialists could work together to
triage patients into the treatment stream they need, because
not everyone needs surgery.

"For those who are legitimately waiting too long, we need to
improve how we organize and deliver care," she said. "Changing
how we pay for care to allow private duplicative insurance is
not the solution."

Palmer said the widespread media coverage of the Fraser
Institute's survey undermines public confidence in the health-
care system. "I think it's unfortunate that it goes out
unchallenged every year."


http://www.cbc.ca/news/health/fraser-institute-wait-time- survey-critique-1.3867927

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