Economic Cost of Wait Times in Canada: Preliminary Assumptions and Findings - PowerPoint PPT Presentation

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Economic Cost of Wait Times in Canada:

Preliminary Assumptions and Findings

Robin Somerville

Director, Corporate Research Services

The Centre for Spatial Economics

CSLS-CMA Invitational Roundtable on Health Care and the Economy

Ottawa, ON

March 7, 2006

BCMA/CMA Study Overview

Rationale
Wait times will always exist in a universal access health care system. The length of the wait time is dependent on multiple factors but waits in excess of recommended maximums impose costs on patients, the health system and the Canadian economy.
Phase I
Estimate the number of patients who are waiting for longer than the recommended maximum period for treatment and the average length of their wait
Preliminary analysis for this phase is complete
Phase II
Estimate the economic costs associated with waiting in excess of the recommended maximum period for treatment
Data collection, assumptions and analysis for this phase is underway

Wait Times Research

Why Wait?
With universal access, wait times represent the substitution of “non-price” rationing for the price rationing that occurs in other competitive markets
Cost of Waiting: Other Research
Cullis and Jones (1986), $5,600 per patient in the UK in 1981
Propper (1990), $1,100 per patient in the UK in 1987
Globerman (1991), $2,900 per patient in Canada in 1989
Esmail (2005), $900-$2,700 per patient in Canada in 2004

Wait Times in Canada

Fraser Institute
Wait times in Canada are falling - slowly
Conference Board of Canada
Wait times in BC, Alberta, Saskatchewan and Ontario are better or near the average for OECD countries with comparable health systems
Public Perception & Policy
Public opinion in Canada favours improved access and shorter wait times
Public policy is attempting to address the issue

Conference Board of Canada:

Wait Time Benchmarking

Gold – represents performance in the top third of OECD countries and provinces

How Long is too Long?

While wait times must exist, the length of wait is a matter of public policy
Prior studies have examined the overall cost of waiting using various methodologies
This study is the first not just the total wait time cost but also the incremental cost of waiting longer than the maximum time recommended by physicians and public health officials
The economic costs will be driven by the:

Impact from reduced productivity of waiting longer for treatment and caring for patients
Additional health costs associated with longer wait times

Wait Times from the Patient’s Perspective

Current Wait Times for Treatment

CABG urgent & elective wait times from the Fraser Institute

CABG provincial wait time data in BC and SK inconsistent with Fraser Institute survey data

Maximum Recommended Wait Time

Fraser Institute: “reasonable” wait time average of 4 provinces

Maximum Wait Times

Wide range of opinion in what constitutes the maximum or reasonable wait time for treatment

Study will use Wait Time Alliance recommended maximum wait times

CABG maximum wait time developed by assuming elective procedures account for 68% of all cases

Excess Wait Time

Current data show that treatment wait times vary considerably by province and procedure

Excess Wait Time Methodology

Observation
If the median wait time equals the maximum recommended wait time, 50% of patients have to wait longer than recommended
Data Requirement
The distribution of patient wait times by procedure and province
Approach
Proportion of patients with excessive wait times multiplied by their average wait (less the recommended maximum wait) yields the average time a patient can expect to wait for treatment beyond the recommended maximum period
The total wait time (or queue) can be estimated by multiplying the previous number by the incidence of the condition and the province’s population

Patient Wait Times

The bolded figure highlights the median patient wait time

The red shading indicates the Wait Time Alliance maximum recommended wait time

Proportion of Patients with Excessive Wait Times

There are always some patients that wait longer than recommended

Average wait for Patients Not Treated Within Recommended Maximum Period

This estimate is based on the proportion of patients treated after the recommended maximum wait time multiplied by the average length of their wait

Expected Wait Beyond Recommended Maximum Wait Time

This table shows the average wait time beyond the recommended maximum that a patient can expect after being scheduled for treatment

Incidence Rates per 100,000 People

Incidence rates are used to estimate the size of the queue in each province in terms of the number of people waiting beyond the recommended maximum period for treatment

Need to look for crude instead of standardized rates

Cataract surgery rates are just for acute/inpatient

The Queue

Size
The overall size of the queue (measured in patients per year waiting in excess of the recommended maximum time) is determined by the number of cases in each province times the probability of waiting beyond the recommended wait time
Patient Characteristics
Patient characteristics are used to help determine the economic cost associated with the queue
Incidence of the condition by: