Health Committee on May 6th, 2008

[Glenda Yeates]

Certainly we know this is an area of critical interest in terms of the health sector, and we do look at a number of these questions. We do not have perfect information about all the questions, as we would like, but we do have a number of points I can respond to in terms of the points you raised.

We know the ratio of positions to population was increasing until about the early nineties, and then it fell a bit and has remained fairly stagnant. We do know that we have about the same number of physicians per population as we did ten years ago, but at the same time we know that medicine has changed: it's increasingly specialized, and we use physicians in a different way. We've seen the increased volumes of activity, so we can understand why, when you look at those ratios, you can feel the pressures we feel as a health system in terms of the numbers.

We also know that internationally Canada has fewer physicians in relation to its population than a number of the other similar countries in the OECD, for example.

We do have the breakdown in terms of those who are immigrating and registering as physicians in Canada, those who have come back to the country, and those who leave. For the last couple of years that we have been measuring this, the number of physicians who are returning to Canada from abroad is in excess of those Canadian physicians who are leaving Canada, so there is a good-news story there.

My understanding, in terms of the numbers of foreign physicians as a proportion of the foreign-trained physicians and as a proportion of the total number of physicians in the population, is that it is relatively stable; it's around the 18% mark, and that at the moment is relatively stable.

With regard to your question about retirement, we do know the physician workforce is aging, and we're tracking an increasing average age of physicians. While we don't know precisely when they will retire, we do know this is certainly an issue that planners need to take into account, as well as the increasing feminization of the workforce because the younger physicians do not work in the same way as the older physicians did.

These are all things we're documenting and trying to provide to health care planners for their benefit and for their purposes.

[The Vice-Chair, Liberal, Lui Temelkovski]

Thank you, Madam Yeates.

Madame Gagnon.

[Christiane Gagnon, Bloc, Québec, QC]

Thank you.

Ms. Yeates, according to the Wait Time Alliance Report Card, Quebec, Ontario and British Columbia seem to be performing better, because they have As and Bs as far as reduction of wait times are concerned for the hip and knee replacements and for cancers.

Saskatchewan and New Brunswick are underperforming. I do not want to criticize them, but I would like to know why Saskatchewan and New Brunswick have Cs, Ds and Fs for reducing wait times. Why is there such a variation from one province to another? Are some provinces better equipped?

My colleague spoke to this issue earlier on. Can you influence the government or the provinces to do things differently so that they would be more proactive?

[Glenda Yeates]

First of all, I must say that the grades given in that document are not ours. They are attributed by the Wait Time Alliance.

[Christiane Gagnon, Bloc, Québec, QC]

What do you think of this data?

[Glenda Yeates]

We make no judgments as to whether one province is better than another. We do not give out any A, B, C or Ds. You would have to ask the alliance what they base those marks on.

The provinces have various strategies. One would emphasize one kind of surgery over another. The organization and concentrations of health care are different. Occupational groups also differ from province to province. There are several explanations for the differences between the provinces.

[Christiane Gagnon, Bloc, Québec, QC]

You can make mention of the differences in data from one province to another, but you do not rate them as the Wait Time Alliance does in handing out marks of A, B, C, D, E, and F. This tells us that for some surgeries, for exemple, one would have reason to be worried in New Brunswick.

Do you value this data?

[Glenda Yeates]

Many organizations are studying wait lists as well as other aspects of the health care system, and they are giving samples. Many things could change in these sectors from one organization to the next, especially if they emphasize any one particular perspective. Therefore, the levels can vary according to the values and the choices that are made. We try to give out the information and to be clear regarding the limits and the definitions, so that people can see for themselves.

[Christiane Gagnon, Bloc, Québec, QC]

Thank you.

Ms. Besner, you say that in general, the wait time for certain interventions—cataract operations, hip or knee replacements, for instance—is not as long as it was five years ago. This is how you explain it: “Most Canadians have better access to health information and advice through telephone help lines.” However, you do not say what this network is, how large it is or how many calls it receives.

Do you have anything to support this statement you made in your presentation? It was on page 1, at about the middle of the second paragraph.

[Dr. Jeanne Besner]

The information lines...

[Christiane Gagnon, Bloc, Québec, QC]

Do all the provinces have them? Is there equal access? Give me an idea of how this proceeds on the ground.

[Dr. Jeanne Besner]

I think that almost every province has them. Most of them are available 24 hours a day and 7 days a week. Some of them are a part of the medical services, others are not. I cannot give you any figures now, but I can send them to you, if you are interested. In most cases, it was one way of ensuring that 50% of the population could access medical services 24 hours a day and 7 days a week. It was a way of reaching this objective. I think that all the provinces have them, but I do not have the precise figures with me.

[The Vice-Chair, Liberal, Lui Temelkovski]

Thank you very much, Madame Gagnon.

Now we'll move on to Mr. Fletcher.

[Steven Fletcher, Conservative, Charleswood—St. James—Assiniboia, MB]

Thank you, Mr. Chair.

This is turning into a very interesting conversation with the witnesses. I'll just make a comment on some of the previous testimony.

I found it astounding that only one one-thousandth of the money that the former prime minister claimed did come out of that Kelowna communiqué. He's been going around the country stating there was a $5-billion agreement, but now we know, as we've always suspected, it was just a non-binding agreement with no impact. No money was set aside, and only one one-thousandth of the money ever flowed. That is very helpful, and I'd like to thank the Health Council of Canada for bringing that out today.

My question is to Ms. Yeates. I trust you've seen the Wait Time Alliance report card that came out a few weeks ago. There are a couple of tables in there, and I'm going to ask for your comments.

Table 2 talks about hip, knee, and a bunch of other procedures. There are areas for improvement, but it looks pretty good. Ontario gets five A's, Manitoba gets three A's and a couple of B's. On table 3, where it's talking about progress on the 10-year plan to strengthen health care--this accord we're talking about--the trends are up. It goes from a D to a C-plus, and from a C to a C-plus. So the trends are improving, it seems, according to the Wait Time Alliance report.

I'd like you to have an opportunity to comment on this report.

[Glenda Yeates]

In general, we gather information, validate it, and put it out for others to use. We do this for committees such as this, for similar committees in the provinces, hospitals, and professional associations, and for groups like the Wait Time Alliance. Some of the sources they cite are from the data we have put out. But the opinions expressed about the data, their evaluations of it, are their own. We are pleased that many people across the country use our data. Some people come to different conclusions using the same data, and that's understandable. We put out the information so that groups who are passionate about this topic will have facts to draw their conclusions from. We don't comment on whether or not we agree with their conclusions.

[Steven Fletcher, Conservative, Charleswood—St. James—Assiniboia, MB]

It's heartening to see that there is improvement. In so many areas, there is work to be done, and I think everyone recognizes it. But there have been significant improvements according to this arm's-length, independent audit.

[Glenda Yeates]

The trends are not clear in all cases. The data are not comparable in all cases, but we see some cases where they are starting to be comparable, and we see some areas of improvement in our own data. We're not shy about where we think the data are comparable. There are other cases where it's still too early to tell, and still other cases where we see no improvement yet.

[Steven Fletcher, Conservative, Charleswood—St. James—Assiniboia, MB]

Thank you, Mr. Chair.

[The Vice-Chair, Liberal, Lui Temelkovski]

Ms. Priddy.

[Penny Priddy, NDP, Surrey North, BC]

When you're looking at comparable data.... I'll go back to that just for a minute. I don't want to pursue the concept of that. When we look at the changes in wait times, undeniably they are there. The piece that is always hard to find is the narrative around the outcome. Are we simply doing more faster? Are people doing well at home, or are they coming back in faster as a result of moving through surgery more quickly? The challenge that I don't think we ever solved through data is the outcome part, other than the outcome being that we completed the surgery. But we don't know the quality of the outcome or the narrative that goes around it. Is there any way to get at that?

[Glenda Yeates]

It's a challenging question to ask overall. The data lend themselves to some aspects of it. For a number of years now, we have routinely indicated readmission rates for certain procedures—stroke and cardiac, for example. In a recent analysis we looked at readmission rates for hip and knee replacements, so we can see what the circumstances are in these cases. But that's not the only outcome. You would want to know how people are doing at home on an ongoing basis. But there are some points of analysis, like readmissions, that try to get at the question of outcomes.

[Penny Priddy, NDP, Surrey North, BC]

Thank you.

[Dr. Jeanne Besner]

I have nothing to add.

[The Vice-Chair, Liberal, Lui Temelkovski]

That concludes our meeting.

My thanks to all the presenters. The report will be coming out many, many weeks after we conclude.

I have a point of information for the committee: The Wait Time Alliance will be here next week, so prepare your questions accordingly.

The meeting is adjourned.