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Medical Forum / General / General / October 2005

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Wait times in Ontario (Canada)

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J - 26 Oct 2005 20:03 GMT
http://www.health.gov.on.ca/transformation/wait_times/wait_mn.html
Wait Times in Ontario

For the first time in this province's history, Ontarians can now find out
how long they can expect to wait for key health services at hospitals.
This site contains the most up-to-date information about wait times in
Ontario, with a breakdown for five specific health services by individual
hospitals that provide those services.

This information will allow people to make informed choices about their
health care, and track the progress the government is making in delivering
on one of its key health care commitments. Wait times are one of the ways
we all measure the quality of the health care we are receiving. The best
medical procedure in the world might not be good enough if it isn't
delivered in time.

The Ontario government has a plan to reduce wait times and increase access
to five major health services: cancer surgery, cardiac procedures,
cataract surgery, hip and knee replacements, as well as MRI and CT exams.

The number of hospitals that were reporting wait times data and the number
of procedures that were completed in July 2005 are summarized in the table
below. The information has been supplied and verified by individual
hospitals as part of the province's Wait Time Strategy.

(See tables and sidebar for more.)

Ontario is in the process of developing a Wait Time Information System
that will be more comprehensive, precise and timely. By December 2006,
this single information system will be established in approximately 50
Ontario hospitals, representing more than 80 per cent of the total volume
for the five health services funded through the Wait Time Strategy.

(Those "services" seem to be Cancer Surgery, Cardiac, Cataract Surgery,
Joint Replacement (Hip/Knee), Diagnostic Tests - MR/CT)
Robert - 26 Oct 2005 21:50 GMT
> http://www.health.gov.on.ca/transformation/wait_times/wait_mn.html
> Wait Times in Ontario
>
> For the first time in this province's history, Ontarians can now find out
> how long they can expect to wait for key health services at hospitals.

How long can a person wait?
Government run programs are a nightmare. Government employees are not
motivated to improve anything. There is no accountability.
The thing is being done because of political pressures and so you end up
with a political answer being handling be political operatives.
The problem is money. They are saving money be making people wait and that
saved money from the GNP based on healthcare dollars spent was transferred
out of healthcare. Give more money to the system and like any other
government program you see waste. There was a problem about wasting blood
products, blood units outdating on the shelf because the hospitals were
ordering lots of blood as they didn't have to pay for it and so they didn't
care if it got wasted. One proposed change was to place more accountability
on the hospital in terms of holding them more financially responsible for
those units. That can't happen with the present system.
The long term answer is what the UK did and what France did and just about
all other countries with a single pay system was to allow a 2 or 3 tier
system. Anything short of that and you will see a continued rotten system.
bae@cs.toronto.no-uce.edu - 27 Oct 2005 02:05 GMT
>> http://www.health.gov.on.ca/transformation/wait_times/wait_mn.html
>> Wait Times in Ontario
[quoted text clipped - 3 lines]
>
>How long can a person wait?

Well, in the US, a person without medical insurance or money to pay for
medical services can wait until they die, or until they get so sick they
can get some emergency care.  These people don't get on waiting lists.

>Government run programs are a nightmare. Government employees are not
>motivated to improve anything. There is no accountability.

No matter how many times people tell you, you won't be informed that
few doctors in Ontario work directly for the government.  Almost all
are in private or group practice and are paid by insurance claims just
as in the US.  The difference is that there is a single payer for most
medical services, and they don't have to spend hours on the phone
arguing with clerks about what is or isn't covered, nor remember the
rules of a dozen different insurance plans, nor do they have to modify
treatment plans based on what a patient can afford, nor treat anyone at
a loss if they can't pay, or go after them to try to collect.

You also refuse to recognize that not only do Canadians live longer
than people in the US, even if they are poor, but survival time after
diagnosis is equal or better for serious illnesses than in the US.  At
the same time, bankruptcies due to medical expenses are rare, everyone
can get preventive care and screening for various conditions, and
people aren't forced to stay in bad marriages or bad jobs for fear of
losing medical insurance for themselves or their family members if they
have an existing condition.  All this at about half the cost per capita
in the US.

>Anything short of that and you will see a continued rotten system.

Far more US residents feel that they have to deal with a rotten system
than Canadian residents.

I've pretty much given up trying to educate you and some other posters
here who know very little about health care systems in developed
countries outside the US, and would rather assume it's some horrible
dystopia they invent in their imaginations than learn something about
the reality with an open mind.
Robert - 27 Oct 2005 04:08 GMT
> >> http://www.health.gov.on.ca/transformation/wait_times/wait_mn.html
> >> Wait Times in Ontario
[quoted text clipped - 7 lines]
> medical services can wait until they die, or until they get so sick they
> can get some emergency care.  These people don't get on waiting lists.

That's true and a good comparison. You are comparing a national health
service that gives the same service as those in the US that don't have
insurance.
That's about right as the lowered Canadian service in trying to get everyone
"free" health is brought to such a low standard as in those of the US
without insurance.

> >Government run programs are a nightmare. Government employees are not
> >motivated to improve anything. There is no accountability.
[quoted text clipped - 8 lines]
> treatment plans based on what a patient can afford, nor treat anyone at
> a loss if they can't pay, or go after them to try to collect.

"Ontario, Canada, is also having a problem with physicians. In this case
there aren't enough to go around. A government report calls for an increase
of 1,000 physicians. Part of the problem is a medical "brain drain."
According to the president of the Canadian Medical Association, Dr. Hugh
Scully, 50 percent of Canadian medical school graduates emigrate within 10
years of graduation and an additional 25 percent leave within 15 years. To
make matters worse, 42 percent of family doctors are refusing to accept new
patients.

The Ontario government has proposed several steps for increasing the number
of physicians, including an attempt to "lure Canadian medical-school
graduates back from the United States, where many have gone for
post-graduate training." It might be worth adding here that with all of the
problems the American health care system has, doctors do not go on strike
and they do not emigrate en masse to single-payer countries in order to
provide better care for their patients.

Access to New Therapies and Technology. In a single-payer system where
health care budgets are tight, bureaucrats and politicians tend to see new
technology as too costly for the benefit. As a result, they usually provide
only enough funds to purchase a limited amount of the newest technology - if
any at all. And the decisions on what to buy and when to buy it are often
arbitrary and guided more by good politics than good medicine.

Even more importantly, these arbitrary limits usually enshrine the medical
knowledge and techniques current at the time of their first imposition. A
central control system cannot afford new medical discoveries and treatments
because they were not in the budget and no funding or other resources were
allocated. Thus, a single-payer system inherently tends to foster outdated
medical techniques and resist new or innovative ones."

Stories abound of Canadians going to extreme measures in order to gain
access to medical technology. For example, several years ago an enterprising
hospital in Guelph, Ontario, decided to allow animals needing CT scans to
enter the hospital in the middle of the night - charging pet owners C$300
apiece. There is nothing necessarily wrong with that except that thousands
of people in Ontario were waiting up to three months for an appointment on
the same machine.

"I'd go any time," said Greg Moulton, who was in the middle of a two-month
wait to learn why he was having "excruciating" headaches. Because people are
not allowed to pay out of pocket for medical procedures covered under the
government-run plan, they have to wait. If you are a dog, you can get
medical technology immediately.

When dogs get better treatment than people, then people will become dogs. In
December 1999, The Washington Post reported that waiting lines for MRIs in
Ontario had grown so long that one Ontario resident "booked himself into a
private veterinary clinic that happened to have one of the machines, listing
himself as 'Fido.'"

http://www.washingtonpolicy.org/HealthCare/PBMatthewsCihakHealthCareQuality.html

> You also refuse to recognize that not only do Canadians live longer
> than people in the US, even if they are poor, but survival time after
[quoted text clipped - 5 lines]
> have an existing condition.  All this at about half the cost per capita
> in the US.

Where do you think the changes came from on the monitoring of the waiting
list?

That's why the Canadian system will not survive the way it is.
People like yourself just simply turn your back on people and let them die
waiting and it takes an act of the Canadian Supreme Court that is unrelated
to the government branch which actually regulates and controls health or the
doctors that you call "private". They did nothing and they will do nothing.
A patient complaining to them does absolutely nothing. You get a case in
court and then all of a sudden all the politicians say that they learned
their lesson. They will monitor waiting times.

> >Anything short of that and you will see a continued rotten system.
>
[quoted text clipped - 6 lines]
> dystopia they invent in their imaginations than learn something about
> the reality with an open mind.

You need to educate your own Canadians who are complaining about your system
but I guess it's not politically expedient to even remotely admit that they
exist. Keep on turning your back on those complaints and see what happens.
The US does not have a national health system for all that forbids any
private competition. If it were to have a national single payer system it
surely would not outlaw other supplemental insurance programs. No other EU
country out there has a system like Canada's. Good luck.
J - 27 Oct 2005 20:51 GMT
> "Ontario, Canada, is also having a problem with physicians. In this case
> there aren't enough to go around. A government report calls for an increase
[quoted text clipped - 4 lines]
> make matters worse, 42 percent of family doctors are refusing to accept new
> patients.

That's right.
There's one doctor, that I'm aware of, keeps saying she's taking more patients, yet
when I went there, 2 years ago, the questinnaire was like applying for employment.
She had a quick glance at what I wrote, asked me 3 questions, then said she had no
time and showed me the door.
And got to bill OHIP for the "visit" whereby she did nothing for me.
I hear she's still "taking new patients". Maybe that's a scam to make easy money???
<g>

Actually, the lady who went in before me was "mistreated". She was elderly and when
she came out of seeing the doctor, remembered that she'd forgotten to ask for a
renew of her med and asked the receiptionist to pop back in ask the doctor for a
script and the doctor said that she didn't have time and the lady would have come
back another time. (she was out of her meds and the doctor couldn't see her for a
week). She left in tears. Heck, her patient folder was right there on the
receiptionist's desk. It only takes a minute to write up a script.

> [...]You need to educate your own Canadians who are complaining about your system
> but I guess it's not politically expedient to even remotely admit that they
[quoted text clipped - 3 lines]
> surely would not outlaw other supplemental insurance programs. No other EU
> country out there has a system like Canada's. Good luck.

I don't see supplmental insurance as a solution, unless it was through the employer,
which sets up another tier of paperwork and resentment for (see below).
There's a huge population who could never afford such.
(many retirees, welfare and disabled)
So one arm of government would have to cover paying the other arm of government.
J - 27 Oct 2005 20:38 GMT
> >> http://www.health.gov.on.ca/transformation/wait_times/wait_mn.html
> >> Wait Times in Ontario
[quoted text clipped - 5 lines]
> Far more US residents feel that they have to deal with a rotten system
> than Canadian residents.

I think you should speak to the 20 million or so in Canada who don't have family
doctors.

> I've pretty much given up trying to educate you and some other posters
> here who know very little about health care systems in developed
> countries outside the US, and would rather assume it's some horrible
> dystopia they invent in their imaginations than learn something about
> the reality with an open mind.

There's a lot wrong with that webpage or info is not being accurately reported.
I think it's a government make work project and "feel good" to the public
endeavor.
But I posted it, in case, some can and need to get elsewhere faster, than in
their area.

It says 13 median days for Diagnositc CT scan.
I've been waiting since last March and been told at least one year.
(there's no "print" function and even if I did show that to the doctor who
ordered the test, he's a bully (walkin clinic) who is quick to show anyone the
door if they're "trouble" and questioning to many doctors is "trouble".

Cataract surgery: 85 Median wait time days.
My friend's mother waited 2 years (once discovered that she could no longer see
the TV and from the date she was approved for surgery and on the list).  The
hospital she consulted with also says 85 days.
They called me as part of a fund-raising campaign a few months ago, and I asked
them about that and they said the wait time is 2 years but worth the wait. So
how come it says 85 days?

Either the data's inaccurate or some "tiers" are getting in earlier.

I've no doubt, that _once diagnosed_ , people with cancer or heart disease get
excellent and prompt care.
But if they've no family or other doctor, how do they get diagnosed?
It takes a doctor to decide which tests and order them.

I think you live in a major centre?
I searched Toronto for physicians taking new patients, a few months ago and 3
names came up.

Patients who have good doctors are happy, those who don't are too afraid to
speak up publicly (a doctor is better than none) and those who don't have one
are stuck with walkin clinics. A municipality nearby had 6 or 7 years ago. 3
years ago, they only had 3.  The 3rd had 4 doctors, 3 left and the last one just
left and closed it down. Leaving two walkin clinics.

We/ve been told for 15 or more years that things will get better.
I just heard that doctors' annual caps were taken off.
Has that changed anything. No, they just push patients through faster, so they
can handle more patients (and bill for more) in a "day" and/or go to their other
"work". Many work elsewhere as well.

If you really want to know what's going on, get out there and poll people after
they leave clinics or doctor's offices (and ensure them confidentiality) but
again, in your area, the situation might be better, so you'd have to pick a
different municipality.
bae@cs.toronto.no-uce.edu - 27 Oct 2005 22:08 GMT
>It says 13 median days for Diagnositc CT scan.
>I've been waiting since last March and been told at least one year.

My husband got one in a few weeks, and that was for something not very
time critical, sciatica.  When the specialist decided surgery was
appropriate, he had it in something like 4 to 5 weeks.  I don't doubt
that there are many true stories about long waits, but just about
everybody I know has had no difficulty in timely access to diagnostic
and treatment facilities.  Normal stuff like this doesn't get
publicised like bad exceptions do.

>Either the data's inaccurate or some "tiers" are getting in earlier.

It helps if you live in a major urban center.

>I think you live in a major centre?

Yes, Toronto.

>I searched Toronto for physicians taking new patients, a few months ago and 3
>names came up.

Where did you search?  My doctor is at a family practice center at a
teaching hospital.  Did you try one of these?  AFAIK, they usually
accept new patients, although your doctor may be a resident rather than
a professor.  I've gotten very good service there, rapid referral to
good specialists when needed, etc.  I've had the same excellent doctor
for about 15 years now.  I followed her when she moved from another
teaching hospital family practice unit.

A family practice center at a teaching hospital may also be able to help
you contact a doctor who has recently completed her residency and is now
in practice elsewhere.  Some of them may be interested in taking on new
patients.

It's true that there's a shortage of doctors, especially specialists,
in rural and remote areas, but that's true in the US as well.  Ontario
recently opened a new medical school in North Bay, in hopes of training
more doctors who will be willing to work in the north and nonurban areas.
fresh~horses - 27 Oct 2005 23:02 GMT
> > >> http://www.health.gov.on.ca/transformation/wait_times/wait_mn.html
> > >> Wait Times in Ontario
[quoted text clipped - 8 lines]
> I think you should speak to the 20 million or so in Canada who don't have family
> doctors.

Can you give me some source for that? I am not asking contentiously,
but sincerely. I was not aware it was so high.

> > I've pretty much given up trying to educate you and some other posters
> > here who know very little about health care systems in developed
[quoted text clipped - 7 lines]
> But I posted it, in case, some can and need to get elsewhere faster, than in
> their area.

There are many who share your thinking here. Health care budgets have
been cut to the bone to satisfy damand for tax cuts. I think front line
physicians are very noble, for the most part, and working long hours
with crushing patient loads. Quite honestly, I think they should have
limited their patient loads long ago.

I too was without a family physician for some time, until I learned
about the hospital clinics. I'm happy with the person recommended to
me, but I see a physician so infrequently. The only drawback, so far
for the three visits I've had, is that it's a teaching hospital. With
all that implies. Everyone's very kind, and thorough. At least, when
I'm conscious. ; )

Zee

> It says 13 median days for Diagnositc CT scan.
> I've been waiting since last March and been told at least one year.
[quoted text clipped - 37 lines]
> again, in your area, the situation might be better, so you'd have to pick a
> different municipality.
J - 29 Oct 2005 01:21 GMT
> > I think you should speak to the 20 million or so in Canada who don't have family
> > doctors.
>
> Can you give me some source for that? I am not asking contentiously,
> but sincerely. I was not aware it was so high.

No, my mistake. The fish that got away grew <g>
http://www.cbc.ca/stories/2004/06/15/sci-tech/doc_lack040614
Says 3.5 million but 2.4 aren't looking, which includes me because I ask everyone I
know and anyone in anything "health" related. I don't know what they mean by not
looking, becasue we're told we're supposed to call each doctor''s office, every day.
We also have Academy of medicine where we can call but not every doctor lists
themselves there.

The only hospital clinic I'm aware of is "Urgent Care". (not ER) at one hospital (of 4
) in the big city nearby.
They don't order up bloodwork for ongoing health conditions, although after spending
two days trying to find someone to give me a steroid shot in my elbow, I ended up
getting one there, but they told me the next time, next doctor might not agree to do
it.  One woman ahead of me probably had bloodwork. she had Type 1 diabetes (young) and
asthma and she was in very rough shape.  They worked on her for hours. I think she
should have been at ER.
They don't renew medications or order up scans, as required. (but he ordered an xray
of my elbow, which I knew I didn't need but was not prepared to argue ("be difficult")
with someone who was going to give me pain relief).
But if a person thinks they broke their arm or leg (or falls), that's the place to go.

I'll have to continue (maybe) later. Bursitis in my elbow.
J
fresh~horses - 29 Oct 2005 01:45 GMT
> > > I think you should speak to the 20 million or so in Canada who don't have family
> > > doctors.
[quoted text clipped - 7 lines]
> know and anyone in anything "health" related. I don't know what they mean by not
> looking,

Well for example me. Since 2001 I was not looking. And the
communications director I work for. She needs a doc she walks into a
medicentre. She's not looking. In fact most of the people I know are
like that. They are mainly young, healthy, without children (and not
planning on getting any).

I wasn't looking until I needed surgery. So now I have one. I walked
into a hospital family clinic and said who's available and sat down for
40 minutes and then told him what I wanted. Just like that. As soon as
I don't need him I'll send him out your way. Seriously, I don't want
one, but for when I *must*.

To be honest with you, the physicians I respect most post here. And
because I can see the tenor of their knowledge and information, and
know something of what they "think", I respect their opinion. But
that's only good when opinion is all I need.

Prior to the last gp which I used the same way I'll use this present
one, I didn't have one for years. Most of my family members don't have
one. But if you are ill, or have a chronic condition you need one.

I think the answer to this problem of there not being enough family
physicians (?! again I dispute this--why does everyone 'need' one?) is
couched in the sentence that refers to medical students not wanting to
be family physicians. They __ just__ don't. Everybody wants to be a
specialist.

I also think physicians don't like to have chronic care patients or
seniors who are likely to need a lot of care, and don't exactly get
well. How unsatisfying. It's like being a housewife; your job is never
done, and it's the same as the last time they saw you. Why do you not
have a gp? You must have, at some time. Either you were unhappy with
them, or they with you to cause you to be without one now, since you
obviously need and want one. (This is not a judgement just a query.)

> We also have Academy of medicine where we can call but not every doctor lists
> themselves there.
[quoted text clipped - 14 lines]
> I'll have to continue (maybe) later. Bursitis in my elbow.
> J
bae@cs.toronto.no-uce.edu - 29 Oct 2005 23:44 GMT
>> > I think you should speak to the 20 million or so in Canada who don't have family
>> > doctors.
[quoted text clipped - 9 lines]
>We also have Academy of medicine where we can call but not every doctor lists
>themselves there.

"Not looking" usually means "not looking".  I didn't feel any need for a
family doctor when I was young and had few health care concerns.  I didn't
have one, and was "not looking" for one.

Who told you to call every doctor's office?  What nonsense.

>The only hospital clinic I'm aware of is "Urgent Care". (not ER) at one hospital (of 4
>) in the big city nearby.

Call up the hospitals and ask for the "family medicine" or "family practice"
clinic.  Or look in the hospital's entry in the phone book.  It may list that
number separately.

Sounds like you took some bad advice, decided it was the only advice, and
concluded that everything's f.cked and you're helpless.  Sheesh.
Robert - 28 Oct 2005 04:28 GMT
"J" <studydras@anon.inv> wrote in message

>It says 13 median days for Diagnositc CT scan

"Waiting times for diagnostic tests also experienced some increases. For
example, the median wait for a CT scan across Canada was five weeks in 1999,
a 6.4 percent increase over 1998."

> I've no doubt, that _once diagnosed_ , people with cancer or heart disease get
> excellent and prompt care.

Finally, in Canada, the Canadian Medical Journal reported in May 1999 that
during a 12-month period, 121 patients waiting for coronary bypass surgery
were removed from the waiting list because their condition had deteriorated
to the point that they were unlikely to survive surgery.

Finally, "Last summer, as waiting lists for chemotherapy treatments for
breast and prostate cancer stretched to four months, Montreal doctors
started to send patients 45 minutes down the highway to Champlain Valley
Physicians' Hospital in Plattsburgh, New York."

As The New York Times points out, "Canada has moved informally to a
two-tier, public-private system. Although private practice is limited to
dentists and veterinarians, 90 percent of Canadians live within 100 miles of
the United States, and many people are crossing the border for private
care."

> We/ve been told for 15 or more years that things will get better.

Although single-payer proponents cite Canada as a system that rivals the
U.S. in the availability of new technology, the country lags behind many of
the Organization for Economic Cooperation and Development (OECD) countries.
While Canada ranks fifth in terms of total health care spending (as a
percent of GDP), a recent study by the Fraser Institute in Canada comparing
OECD data found the country:

· Ranks 21 out of 28 in CT scanner availability;

· Is 19th out of 22 in lithotriptor availability;

· And 19th out of 27 for the availability or MRIs.

It should be mentioned that these are not cutting-edge medical
technologies - at least not in the U.S.

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