HSCI 305 Lecture Notes - Lecture 9: Joint Replacement, Fraser Institute, Radiation Therapy

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HSCI 305 Lecture 9  Privatization Issues
1. Wait times Challenges and Solutions:
a. Seek care abroad
b. Parallel private health insurance
2. Bound up with Legal Challenges
a. Privatization or...
b. Innovation in the public system?
3. Models of Privatization
Wait Lists Wait Times
Lists for:
-Non-emergency surgical or
diagnostic procedures
-Appointments with specialists
Time between identifying the need for treatment
and receiving appropriate treatment
Most facilities and providers maintain their own
lists
Not easy to calculatereferral from GP?
Diagnosis date? Specialist decision to treat?
Hospital wait list?
Significance varies depending on:
-Treatment needed
-Impact on patients
Media attention to wait lists & wait times have
made Canadians doubt the quality of their
healthcare system
2004 Health Accord
-Identified wait time reduction as a top priority
-Five priority clinical areas:
oCancer
oHeart
oDiagnostic imaging
oJoint replacement
oSight restoration
-Target time frames set out for procedures: goal to treat 90% of patients within
recommended time frames
Measuring Wait Times
-Canadian Institute for Health Information (CIHI) 2008—the data about who is waiting
for what, for how long and the factors that influence waiting are still far from comprehensive
-CIHI 2013—significant improvements in measuring and reporting wait times
consistently across provinces in most clinical areas
Progress
-2010:
oTime frame targets met for >90% of patients receiving radiation therapy and about
80% of patients receiving other priority procedures
-2012:
oMore procedures performed—15% more joint replacements than 2010
oNot enough to keep up with demand—no improvement in wait times over 2010
Supply and Demand
-More people over 65 in 2012 than in 2010
-Increasing prevalence of conditions such as osteoarthritis & obesity
-Improvements in prostheses
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-Changes in surgical practices
oDocs recommending joint replacements for younger populations—biggest increases
for hip & knee replacements 1998-2008 among those 45-54
International Perspective
-41% Canadian patients had to wait more than 2 months to see a specialist
-28% in Australia and France
-19% in UK
-9% in US and 7% in Germany
Why are we waiting so long?
-103 specialists per 100 000 Canadians in 2011 (91 in 2003)
What determines who waits longest for specialty care?
-Percentage of patients waiting over three months to see a specialist, by condition
o31% arthritis, 7% heart condition or stroke
-Life-threatening conditions get priority
o50% get cancer radiation therapy treatment in 7 days or less, 90% 19 days (2012)
Wait Time Solutions
-Individual level—seek
-Parallel private health: two tiered system
-Innovation in the public system
Seek care in US?
-American opponents of universal public coverage have argued that constraints on
capacity and funding force hordes of Canadian “Medical refugees” to cross the border
-Eg – Fraser Institute report claims >45 000 Canadians sought treatment outside
Canada 2011
Why do Canadians get care abroad?
-Wait times at home too long
-Highly specialized technology not available in Canada
-Proximity
-Coincidental services (snowbirds, business/leisure travelers)
-Perception of higher quality
The Power of Numbers
-How did the Fraser Institute arrive at these conclusions?
o“Approximately what percentage of your patients received non emergency medical
treatment in the past 12 months outside of Canada?” + CIHI data on procedures in Canada
o16% response rate in 2010
Medical “refugees” What does reliable evidence say?
-Katz et al., 2002 published in Health Affairs
-Information collected from US hospitals, provincial Ministries of Health & Insurance
claims
-“the numbers found are so small as to be barely detectable relative to the use of care
by Canadians at home”
-CIHI—surveyed patients to estimate cross-border care-seeking
-<0.1% of Canadians report being treated in the US
-“Despite concerns to the contrary, cross-border care-seeking is too rare to be reliably
measured”
-Advanced imaging & eye procedures:
oVery few Canadians seek care in the US
oRelative to the large volume of these procedures provided to Canadians at home, the
numbers are almost undetectable
oMost Canadian admissions to US hospitals were unrelated to waiting time
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Document Summary

Most facilities and providers maintain their own lists. Time between identifying the need for treatment and receiving appropriate treatment. Media attention to wait lists & wait times have made canadians doubt the quality of their healthcare system. Identified wait time reduction as a top priority. Target time frames set out for procedures: goal to treat 90% of patients within o o o o o recommended time frames. Canadian institute for health information (cihi) 2008 the data about who is waiting for what, for how long and the factors that influence waiting are still far from comprehensive consistently across provinces in most clinical areas. Cihi 2013 significant improvements in measuring and reporting wait times. Time frame targets met for >90% of patients receiving radiation therapy and about o. 80% of patients receiving other priority procedures o o. More procedures performed 15% more joint replacements than 2010. Not enough to keep up with demand no improvement in wait times over 2010.

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