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Abstract

For some time, the issue of waiting lists and waiting times has played a significant role in the debate about access to health care services in Canada. They are increasingly being blamed for hindering reasonable access to health care services and governments across Canada, both provincial and federal, are continually called on the address the issue of waiting lists and waiting times. A comprehensive understanding of the nature of waiting lists and waiting times is critical to the development of effective policies. The evidence regarding the nature of the waiting lists and waiting times and the factors affecting them remains in the early stages. The purpose of the study is to contribute to a more comprehensive understanding of the nature of the waiting lists and waiting times. Specifically, the study seeks to: (1) critically review the published and unpublished literature; (2) develop a conceptual framework identifying various patient, physician and hospital factors that may affect waiting lists and waiting times; (3) assess the validity and reliability of the B.C. Surgical Waiting List Data (SWL); and (4) identify patient, physician and hospital factors that significantly affect patient waiting time. The study focuses on four surgical procedures: knee replacement, hip replacement, cardiac and cataract surgery. Literature Review A critical review of the existing literature from Canada and abroad revealed several key themes and gaps in our understanding of waiting lists and waiting times. First, the accuracy of waiting list data and the validity and reliability of key measures (i.e. "date-on", "date-off', waiting list size) are often suspect. Second, the evidence regarding factors affecting waiting lists and waiting times remains in the early stages of development and as such, there are significant gaps in the evidence. Validity/Reliability of the SWL Data The accuracy of the SWL data were assessed using established data assessment methods for a single and multiple data sets. Additional administrative health care data, hospital separations and physician billing data, were used to assess the validity of the SWL. Overall, the data appear to be valid and reliable accurately representing those patients placed on the waiting list. Linkages of the SWL data with the hospital separation and physician billing data were highly successful and resulted in high rates of matching for most variables on the SWL. A validity assessment of "date-on" the waiting list revealed that in most cases (50%-60%) patient were placed on the waiting list following their last pre-surgical consultation. A similar assessment for "date-off revealed that most patients (> 90%) were removed from the list on the day of their surgery. The validity of waiting list size, however, revealed that the SWL may under-represent the total population undergoing surgery for the selected procedures. Factors affecting Waiting Times Autoregressive models (AR1) were used to identify significant patient, physician and hospital factors affecting individual patient waiting times. The final models explained between 58% (cataract surgery) and 61% (knee and hip replacement) of the variation in patient waiting times. The results of the analyses clearly indicate that patient factors represent most of the explained variation. Specifically, variables representing clinical status (urgent/emergent), placement on the waiting list and movement on the waiting list were significantly associated with patient waiting time. These findings have implications for policy options available to address the issue of waiting lists and waiting times.