Viberg N, Forsberg BC, Borowitz M, Molin R. International comparisons of waiting times in health care – Limitations and prospects. Health Policy. 2013, in press. Available at http://dx.doi.org/10.1016/j.healthpol.2013.06.013; accessed October 6, 2013.
The politics of health care in Canada often revolve around wait times, whether for elective surgery, diagnostic procedures, or specialist evaluations.
Many countries have established national monitoring and data collection systems to provide information on wait times.
But can we compare waiting times in one country with those in another?
Methods and limitations
In this report from the highly regarded Karolinska Institute in Sweden, the investigators describe the ways in which 23 OECD countries measure waiting times to assess whether waiting times can be compared internationally.
The investigators searched the internet for published reports in the scientific press and for relevant non-scientific documents, and studied the web sites of governmental organizations that direct health policy. They interviewed key informants to clarify or obtain additional information.
Due to the diversity of approaches in measuring wait times across countries, the investigators compared wait times only for 3 categories of elective surgeries —elective surgery aggregated, total hip replacement surgery, and cataract surgery — as these data are the most commonly available.
Findings and Analysis
Only 15 of the 23 countries included in the study monitor and publish national waiting time statistics: Sweden, Denmark, Finland, Norway, England, Scotland, Wales, Northern Ireland, Ireland, Portugal, Spain, the Netherlands, Canada, New Zealand and Australia. There is no national monitoring in Austria, Greece, France, Germany, Belgium, Luxemburg, and incomplete monitoring in Italy. The US has only specific national monitoring.
The 15 countries with extensive national wait-time statistics, including Canada, have some kind of national wait-time guarantee and tend to monitor timeliness of access to specialist care, but not primary care. This may include specialist appointments, emergency visits, diagnostic interventions, elective surgery as a whole, or specific surgical procedures.
The researchers noted three distinct metrics for calculating wait times in the 15 countries:
• Retrospective waits for patients whose intervention is completed
• Ongoing waits for patients currently in queue
• Expected waits for newly referred patients
Another methodologic variable was determining the beginning of a wait. A few countries begin counting at the initial contact, even a phone call, at the primary care level. Other points of wait-time outset include:
• Initiation of specialty referral by primary care
• Decision of specialists to undertake a procedure
• Entry of patients into queue for a procedure
Some countries use more than one metric, but the plurality, including Canada, use the decision-to-treat as the beginning of the wait.
The analysis shows that it is difficult to make meaningful comparisons of officially published waiting times in the 15 countries studied, due to the many methodological differences in measuring waits.
It is not reasonable to conclude that if a country does not monitor waiting times, then waiting times are not a problem. In countries where waiting times are not registered and reported, accessibility may still be an issue, or it may not. We simply don’t know.
For example, France is often cited as a country has no waiting time problems, yet without a national monitoring system, this conclusion is suspect. Sweden has been identified as a country with relatively long waiting times, but this cannot be confirmed because the national statistics are incomparable.
Proponents of two-tier health care —advocates for allowing private payment to gain faster access to care — cite European countries as models for Canada, claiming their waiting times are shorter. Yet with no meaningful basis for wait time comparison, advocacy based on this polemic is spurious.