Par Danylo Hawaleshka
When it comes to improving wait times and access to health care, Canadians are still waiting. While the provinces insist that a majority of patients come away happy -- and many do -- a significant minority continues to report trouble getting medical attention. According to a recent survey by Statistics Canada, one in five patients trying to see a specialist reported some sort of difficulty last year; one in eight had trouble getting non-emergency surgery; and another one in eight reported being less than satisfied with their experience in obtaining a diagnostic test. In up to two-thirds of those cases, the single largest complaint was having to wait too long.

Quebec, however, was distinctly different. In a report released earlier this month, Statistics Canada noted that the median wait time for non-emergency surgery in Quebec has fallen by half, from 8.6 weeks in 2003 to just 4.3 weeks in 2005. The other provinces stayed flat, except for B.C., where the median wait time rose from 4.3 weeks to five, and Newfoundland and Labrador, where it climbed to 4.3 weeks from four. Quebec also more than held its own with regard to specialists. Here, the median wait time to see one for a new condition was three weeks in 2005, unchanged from 2003. In all other provinces that time was four weeks or longer, and in Manitoba and points west, it actually increased.

So why Quebec? The StatsCan report is based on a telephone poll of 33,539 Canadians, so the results are subjective, relying on memory. But there are obvious possible explanations for Quebec's progress, says Marie-Pascale Pomey, a Université de Montréal professor of health administration. In late 2003, the Quebec government reorganized care so that in Montreal, for example, 54 previously independent institutions were amalgamated into 12 regional "health and social service centres." Under the new system, the most dramatic improvement occurred with cataract surgeries, Pomey says. The locations performing the operation were consolidated into three for the entire island. Now, surgeons have dedicated cataract operating rooms, and specialized staff. The initial goal in centralizing care was to perform 20,000 surgeries annually, Pomey says, but efficiency was so high that 28,000 procedures were completed. "All the surgeons who practised in the other sites had to find another place to work -- there was no discussion, and there was strong resistance at first," Pomey says. "But in only a few months, there were no more patients waiting the maximum, medically acceptable time."

Quebec also says it has better targeted its health care dollars since 2002, reallocating $47 million annually for hip and knee replacements, as well as cataract surgeries. And an additional $50 million of new money this year is going toward reducing wait times for day surgery and surgeries requiring hospitalization, says Nathalie Pitre, a spokeswoman for the Quebec Ministry of Health and Social Services. The revamping includes better management of the wait lists themselves. If a patient is in Florida for the winter, for instance, he's temporarily removed from the list because he's clearly unavailable. Same for those whose operations are likely to have a poor outcome due to other medical conditions. "This way," Pitre says, "the people who are on those waiting lists are there for a good reason."

One cannot, however, measure wait times without controversy. Dr. Louis Morazain, vice-president of the Quebec Federation of Medical Specialists, is stunned by Statistics Canada's report that the median wait time to see a specialist in Quebec was just three weeks. "In psychiatry, it's one year; in ophthalmology, six months; in orthopedics, it's something between four and six months to see someone," Morazain says. "I'm sure their number doesn't correspond to reality."

Meantime, clearing patient backlogs has left some surgeons looking for work. In Montreal, Pomey says one hospital is so desperate to fill its cataract operating theatre it has begun placing ads for new patients. Faced with a patient shortage, doctors are also inclined to relax the rules so more patients can qualify for the surgery. "When there are no more waiting lists," Pomey says, "the surgeons change the criteria." Which only increases wait times. Plus ça change . . .
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