• Canada's Healthcare wait times hit 20 weeks in 2016: report

    From TrumpenFuehrer News Network@21:1/5 to Ubiquitous on Fri Nov 23 16:04:03 2018
    XPost: alt.tv.pol-incorrect, alt.politics.usa, alt.fan.rush-limbaugh
    XPost: can.med, can.politics

    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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