Thank you, and good morning. Thank you for that introduction.
I am Glenda Yeates, the president and CEO of the Canadian Institute for Health Information, or CIHI. Thank you for inviting me to be present before the committee.
As you may be aware, I'm going to focus on the data slides we have presented, which are in front of you. The CIHI is an independent organization that provides accurate, timely, and unbiased health information. It's not our role at CIHI to forecast or to offer recommendations or opinions, and therefore my presentation will focus on data.
What we do at CIHI is collect and process databases and registries. We coordinate and promote the development of data standards across the country, we identify health indicators, and we produce analytical products and reports.
In terms of our relationship to the 2004 health accord, this is an accord that had a series of commitments, one of which was reducing wait times and improving access. CIHI is named specifically in the accord and asked to report on progress on wait times across the jurisdictions.
You'll see that we have produced four reports on wait times since the 2004 accord, between the period of March 2006 and the most recent one this last February 2008.
I'll put some of the information on wait times before you today. I'm going to organize it in two ways. The first is to talk about the volume of activity of procedures in the priority areas and the second is to tell us what we know about wait times, or perhaps changes in wait times.
Slide 6 of our presentation looks at what we know about surgical volumes in the priority areas that are named in the accord. They are listed there.
We look at volumes because our data there is more comprehensive and therefore easier to measure. Also, increasing the volume of activity in these areas has been one of the strategies the provinces have specifically named as they try to move forward to reduce wait times.
Generally speaking, our data indicate that the volume of surgery in priority areas, that is, hip and knee replacement, cataract surgery, bypass surgery and cancer surgery, has increased by 13% in Canada, excluding data from Quebec, over the two years following the accord.
Overall, our numbers show that in the priority areas, the volume of surgeries in those areas named in the accord have increased by 13% across Canada over the two-year period following the accord, and that's excluding the volumes from Quebec.
In terms of reporting what those volume increases mean for wait times, what we know now is that most provinces are regularly reporting on wait times for priority areas. There have been improvements in that reporting, so there are more timely, comprehensive data available, but there are still variations in measurement in reporting, and that means interprovincial comparisons are difficult. And the trend data are not available across the board, but they are beginning to emerge for individual provinces.
There's an example from our February 2008 report for joint replacements--one of the priority areas. You can see there that all ten provinces are reporting in the area of hip and knee replacement. We can see the differences in some of the definitions in the provinces, and we note them there, in terms of what those differences in definitions are. You'll see that the reporting in terms of times is included for those two procedures.
The question that people often want answered is what does that mean in terms of wait times? We see that volumes are up. What does it mean for waiting times for individual Canadians? We've put forward the areas for a number of provinces where we feel the definitions have stayed stable enough over the last three years so that we can actually begin to look at trends. So in the area of joint replacement, those provinces would be Ontario, Alberta, and British Columbia. And for those provinces where we think the data are consistent enough, we can see that they report decreases in the median wait times for hip replacements of at least one month for hips and one month and a half for knees.
If you look at cataract surgeries, the story isn't as clear. We see in four provinces that we find the definitions to be consistent enough over that period where we can look at trends. For those provinces, some of them have reported decreases in wait times, but others have not seen decreases.
I will turn next to slide eight. This looks at diagnostic imaging. This is the next area, and another area that was named in the accord. What have the trends been there? Again, the data are stronger on volumes, so you'll see in this that we can look at the volumes of both diagnostic imaging equipment in the areas of MRI and CT scans and the number of exams that have occurred. So we can see between the two periods here, 2003-04 and 2006-07, that there are more scanners--27% more MRIs and 12% more CT scans--and the number of actual exams is up even greater. But what we don't know and aren't able to tell you is what that means for the wait for those procedures. We can see that there are increased volumes. What we don't know is what that impact has been on the waiting times for Canadians.
I will turn next to the access to health care professionals. This was another of the areas that was cited in the access portion of the accord. What we can see there is that there is no comparable indicator for access to health care professionals, so we cannot report on that. That hasn't been determined. But what we can see is CIHI does have data about numbers of practitioners. Here I show you the numbers of physicians and nurses. We can see those numbers are up modestly in the 2004 to 2006 period, but those increases are not particularly significant, given the increase in the population that has also occurred in that time. But we do have data there on the increase in the numbers of health professionals in those two professions.
Another question that has been posed to us about the accord from time to time is the question of whether the new federal money that was committed in the accord was in fact spent on health care, and I've included there the table that is appended to the actual 2004 accord. At CIHI we collect and analyze data on health spending at a national level, so that is a question at the broadest level that we can answer. Our data do show that in 2005 the provincial and territorial governments spent almost $91 billion on health care, which was an increase of about $6.1 billion over the 2004 level. And when you compare that to the accord, you would see that the accord put in $3.1 billion of new money in the 2005-06 period. So we can get some sense of that investment flowing to the health care sector, in terms of the expenditures of provinces and territories.
In conclusion, on the progress on wait times reporting--the task given to us in the accord--we do see increased activity in the priority areas. There are increased diagnostic imaging procedures and there are increases in the surgeries in the priority areas.
We do see improvements in the data. There is much more data than there was three years ago. In terms of the interprovincial comparisons, those are still a challenge, because the data is not collected in precisely the same way or using the same definitions across all the provinces. We do see pockets of trends that are beginning to emerge in individual provinces.
In conclusion, what we can say about progress in wait times is that while interprovincial comparisons remain a challenge, we are seeing increased activity in priority areas, improvements overall in wait times data being reported to the public and pockets of trends that are beginning to emerge.
Thank you.