Wait List Management

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

Abstract

The development and implementation of Pan-Canadian medically acceptable maximum waiting times was given further impetus from the 2004 First Ministers' Accord on Health Care and a federal infusion of $5.5 blllion over ten years.

Purpose of health policy or idea

In September 2004 the First Ministers targeted evidence-based wait list mananagement as a critical concern and the federal government earmarked $5.5 billion over 10 years through the Wait List Reduction Fund for the reduction in the wait lists   for five key health areas including cancer, cardiac care,, diagnostic imaging, joint replacements, and sight restoration, while recognizing the different starting points, priorities, and strategies across jurisdictions.

Main points

Main objectives

The main objectives of the First Ministers' Agreement and the Wait List Reduction Fund is a meaningful reduction in wait lists for the priority health areas by March 31, 2007.

Type of incentives

Non-financial. There is an excellent potential for reductions in health care costs due to improved coordination of care.

Groups affected

Patients, Canadian Public, Health care researchers, Federal/provincial/territorial Ministeries of Health, Regional Health Authorities, Institutional managers, Health care providers, Private sector (e.g. IT development)

Innovationsgrad	traditionell		innovativ
Kontroversität	unumstritten		kontrovers
Strukturelle Wirkung	marginal		fundamental
Medienpräsenz	sehr gering		sehr hoch
Übertragbarkeit	sehr systemabhängig		systemneutral

 As noted in the previous surveys, wait list management has been on the Canadian agenda for several years. The infusion of dollars into research, human resources, and capacity building has led to an unprecedented acceleration of activities.

Political and economic background

The issue of waiting times continues to top Canadians' list of concerns about the health care system.  Despite its prominence in public opinion and media attention, there is a serious lack of data on who is waiting, for how long, and  what (if any) the detriments are to their health.  So (with a few exceptions) it remains difficult to determine the extent of the waiting problem from a public health point of view or to apportion the source of the problem between under-investment in personnel and equipment and inadequate management of queues.

There have been many innovations and development in wait list management in recent years at the provincial, regional and institutional levels. This development was accelerated in the fall of 2004 wherein the First Ministers' stipiulated the need for the provision of medically acceptable Pan-Canadian benchmarks (though allowances could be made for regional needs). Within the First Ministers' 10 year plan to strengthen health care (2004) is the development of a Wait List Reduction Fund (WLRF) in which the federal government earmarked $5.5 billion (Cnd) over a ten year period to fund innovations in wait list mangament to reduce backlogs in waiting times for medical procedures (http://www.hcsc.gc.ca/english/hca2003/fmm/index.html).

This WLRF targets provincial and territorial investments in reducing wait list times for priority areas such as cancer, heart, diagnostic imaging, joint replacements, and sight restoration by March 31, 2007. More specifically, the WLRF is intended to augment provincial and territorial backlogs in waiting time through investments in human resources, research through regional centres of excllence, the enhancement of capacity in ambulatory and community care programs, and the development of appropriate tools to manage wait times. The First Ministers agreed to report to their citizens on jurisdictional  activities around the development of comparable indicators to health care professionals, diagnostic and treatment procedures by December 31, 2005, and the development of evidence-based benchmarks for medically acceptable wait times for the priority medical procedures by December 31, 2007. The First Ministers' also agreed to develop multiyear targets to achieve priority benchmarks within their jurisdictions by December 31, 2007 and effectively communicate the progress of meeting these multi-year targets to their citizens. 

Change based on an overall national health policy statement

2004 First Ministers' Accord on Health Care - 10 Year Plan for Health Care.

Purpose and process analysis

Current Process Stages

	Idee	Pilotprojekt	Strategiepapier	Gesetzgebung	Umsetzung	Evaluation	Veränderung/Richtungswechsel
Implemented in this survey?

Origins of health policy idea

The First Ministers' 10 Year Plan to Strengthen Health Care emphasizes the need for interprovincial cooperation and the participation of various stakeholders.

Underscoring the politics is the proliferation of innovations in centralized wait list management within institutions, research communities and provincial and regional governments. For instance, the Western Canada Waiting List Project (1999-2004), a partnership of medical association, ministeries of health, regional health authorities and health research centres was created with the mandate to develop and evaluate list management using priority criteria scores to ensure fairness in accessibility, and the standardization of maximum waiting times to ensure timeliness.

The international scope of waiting list time reduction, such as the New Zealand prioritization assessment tool have influenced Canadian innovations. Key Canadian innovations on centralized reporting and wait list management include the Saskatchewan Surgery Wait list website (www.sasksurgery.ca), the Cancer Care Ontario (http://www.cancercare.on.ca/default.htm) and the Ontario Cardiac Care Network (http://www.ccn.on.ca/).

Initiators of idea/main actors

• Regierung

• Leistungserbringer: The Wait List Alliance, composed of specialists in nuclear medicine, orthopaedics, opthalmolgists, cardiovascular medicine, and radiation oncology, through their report No Time to Wait (2005) provided one of the first steps to reduction of wait lists.

• Wissenschaft: Health care researchers, for instance, those involved in the Western Canadian Wait List project, have been influential in developing and testing criteria for wait list management.

Approach of idea

The approach of the idea is described as:
renewed: The legalities of wait list guarantees are somewhat vague within the latest versions of acceptable wait list managements. However, it is plausible that the legal context will re-emerge within the public and political discourses.

Innovation or pilot project

Local level - Saskatchewan Health information: on www.sasksurgery.ca; Ontario has developed centralized reporting systems on cancer care and cardiac care. Key: sharing of best practices and lessons learned ;CPRN moderated Taming of the Queue Colloquiums (2004 and 2005)

Stakeholder positions

Wait list management is not new on the Canadian scene. The codification of patient rights, the possibilities of ensuring guarantees have been suggested and/or implemented at various time within Canada. The impetus for current activities comes from the infusion of funding through the WLRF for research, human resources and capacity building which would accelerate the augmentation of backlogs and better support juridscitional initiatives in wait time reduction. The committment made by the First Ministers to explicit wait list management targets and the infusion of funds may spur change.

In March, 2005, The Wait List Alliance, which is composed of representatives from the Canadian Medical Association, the Canadian Association of Radiologists, the Canadian Cardiovascular Society, the Canadian Association of Nuclear Medicine, the Canadian Orthopaedic Association, the Canadian Ophthalmological Society, and the Canadian Association of Radiation Oncologists, released an interim report No Time to Wait which provides a recommended timetable for acceptable waiting times for diagnostic tests and treatments for the five priorities targeted under the Wait List Reduction Fund.

The "medically acceptable" wait lists recommendations are outlined by the Wait  List Alliance as follows:

• Joint replacement: routine hip and knee replacements should be done within nine months, with patients waiting no more than three months for a consultation and six months for surgery;
• Sight restoration: Routine cataract surgery should be done within four months for all patients;
• Cancer care: Patients should not wait for radiation therapy beyond ten working day;
• Cardiac Care: non-urgent by-pass surgery should be done in less than six months; and
• Diagnostic imaging: CT scans, MRIs and other nuclear medicine tests should be done within seven days for all patients.

Actors and positions

Regierung
Federal Ministery of Health	sehr unterstützend		stark dagegen
Provincial Ministeries of Health	sehr unterstützend		stark dagegen
Regional Health Authorities	sehr unterstützend		stark dagegen
Leistungserbringer
Cardiovascular surgeons	sehr unterstützend		stark dagegen
Radiologists	sehr unterstützend		stark dagegen
Orthopaedic surgeons	sehr unterstützend		stark dagegen
Wissenschaft
Health Care Researchers	sehr unterstützend		stark dagegen

Influences in policy making and legislation

These waiting list reductions have not been formalized within Canadian legislation as guarantees and are therefore not legally enforceable.

Legislative outcome

n/a

Actors and influence

Regierung
Federal Ministery of Health	sehr groß		kein
Provincial Ministeries of Health	sehr groß		kein
Regional Health Authorities	sehr groß		kein
Leistungserbringer
Cardiovascular surgeons	sehr groß		kein
Radiologists	sehr groß		kein
Orthopaedic surgeons	sehr groß		kein
Wissenschaft
Health Care Researchers	sehr groß		kein

Positions and Influences at a glance

Adoption and implementation

A collaborative and coordinated approach between the various stakeholders, including citizens, providers, governments, private entrepreneurs (e.g. in IT development) and researchers is needed to ensure that appropriate benchmarks are in place within regions and throughout Canada. There is also a need for coordination between government departments to ensure that appropriate human resources, institutional capacity, and equipment are available. For instance, clearing backlogs of patients requires appropriate personnel planning, institutional capacity and innovations through research and entrepreneurship. This sharing of best practices and lessons learned has been facilitated through external organizations, such as the "Taming of the Queues" seminars sponsored by the Canadian Medical Association and the Canadian Policy Research Networks. The participation of the patient/citizen, however, within the development of acceptable wait list times beyond the mechanism of reports, is rarely explicated.  

Monitoring and evaluation

The provinces and territories will annually to their citizen on their progress in meeting their multi-year targets and the Canadian Institute for Health Information will report on progress on wait times across jurisdictions.

Review mechanisms

Halbzeitevaluation, Abschlussevaluation (extern)

Dimensions of evaluation

Ergebnis

Results of evaluation

These will be reported in forthcoming surveys.

Expected outcome

The inclusion of target dates does provide benchmarks for provincial/territorial activity around wait list management tthus improving the chances tracking expenditures and improving accountability.The expected outcome is the reasonable reduction in wait time management for joint replacement, access to cardiac and cancer care, diagnostic imaging, and eye restoriation by March 31, 2007. The meaning of "reasonable" is being defined through the development of medically-sound criteria.

Impact of this policy

Qualität	kaum Einfluss		starker Einfluss
Gerechtigkeit	System weniger gerecht		System gerechter
Kosteneffizienz	sehr gering		sehr hoch

The infusion of monies into wait lst management through the Wait List Reduction Fund may accelerates  the reduction of waitlist backlogs by ideally ensuring adequate levels of personnel and institutional capacity. There have been movements toward the development of medically acceptable waitlists and activities around wait list management, but at this stage it is too soon to know the effects on wait lists.

References

Sources of Information

Wait List Alliance (2005). No More Time to Wait: Towards Benchmarks and Best Practices in Wait Time Management - www.cma.ca/multimedia/CMA/Content_Images/Inside_cma/Media_Release/pdf/2005/no_more_wait.pdf

Fooks, C. (2004). Taming of the Queue: Wait Time Measurement, Monitoring and Management. CPRN. www.cprn.org

First Ministers' Meeting on the Future of Health Care (2004). A Ten-Year Plan to Strengthen Health Care - www.hc-sc.ca/english/hca2003/fmm/index.html

Reform formerly reported in

A guarantee of timely care Process Stages: Umsetzung

Guarantee of timely care - implementation delays Process Stages: Umsetzung

Health Care Guarantee Proposal Process Stages: Idee

Health Care Guarantees losing favour? Process Stages: Strategiepapier

Author/s and/or contributors to this survey

Renée C. Torgerson

Canadian Policy Research Network

Empfohlene Zitierweise für diesen Online-Artikel:

Renée C. Torgerson. "Wait List Management". Health Policy Monitor, April 2005. Available at http://www.hpm.org/survey/ca/b5/1