Evidence of meeting #27 for Health in the 39th Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was data.

A recording is available from Parliament.

On the agenda

MPs speaking

Also speaking

Glenda Yeates  President and Chief Executive Officer, Canadian Institute for Health Information
Jeanne Besner  Chair, Health Council of Canada
Donald Juzwishin  Chief Executive Officer, Health Council of Canada
Kathleen Morris  Consultant, Canadian Institute for Health Information

11:50 a.m.

Chief Executive Officer, Health Council of Canada

Dr. Donald Juzwishin

I might just add to Dr. Besner's comments. There have been some very successful initiatives across the country. The difficulty is we haven't had that conversation in a pan-Canadian context, so the Western Healthcare Improvement Network in British Columbia, or the Health Quality Council of Alberta, the Saskatchewan Health Quality Council, the new one announced in New Brunswick, the one in Quebec, all of these are gems of good efforts to try to advance the conversation within the regional context.

What we need now is to provide some cementing of that conversation that can help carry this agenda forward nationally.

11:50 a.m.

Conservative

Patricia Davidson Conservative Sarnia—Lambton, ON

I gather from this that one of the things this committee could be looking at as a recommendation is further and better cooperation among the different groups.

11:50 a.m.

Chair, Health Council of Canada

Dr. Jeanne Besner

That would be extremely helpful, and it reflects the spirit of the accord. There was to be pan-Canadian visioning and collaboration on moving things forward, so yes, reinforcing that would be lovely.

11:50 a.m.

Conservative

Patricia Davidson Conservative Sarnia—Lambton, ON

I want to ask a question on wait times. It was my understanding that when we entered into this accord the starting point for each province may have differed from province to province. Now each province is pursuing its own priorities and its strategies, I believe, for wait times, so in the five priority areas, how do we compare from province to province or area to area how we are having success or where we're not having success?

11:55 a.m.

President and Chief Executive Officer, Canadian Institute for Health Information

Glenda Yeates

At this point I would answer your question in three ways as per our ability to look at this. In the data limitations we now have we can simply look at the question of volumes. Were more procedures done in the different areas? When you look at those numbers you can see reflected the different priorities in the different areas. You can also look at the different starting points on the rates of procedures. For example, on a population basis, some provinces have much higher rates of cataract surgery or hip replacement surgery going into the accord, so one might expect that looking at rates would be helpful so you can see how one province now compares to others in that way.

Finally, the thing we would like to have is to be able to look at the actual waiting times. Does it take six months? Does it take three months? Does it take three weeks to get a given type of procedure in one part of the country versus the other?

What we can see from the tables we have put together now is that we are closer to that point, no question. You can see the definitions do converge, but it's still not the case that we can say definitively that the same procedure will take two months in Nova Scotia and four months or two weeks in British Columbia. We can see if the reported wait is four weeks in one spot and two weeks in another, if they are including emergency cases or they are not, if they are starting the clock and stopping it in the same period of time. If there are differences, you can at least have some ability to assess where those different definitions might lead you, but at this point there is still a lack of comparison in that third component as we look across the country.

11:55 a.m.

Conservative

Patricia Davidson Conservative Sarnia—Lambton, ON

Are we on track to evaluate this down the road as we continue with the accord, or do we need to make changes there too?

11:55 a.m.

President and Chief Executive Officer, Canadian Institute for Health Information

Glenda Yeates

I think there has been convergence. Those who are interested in comparable reporting would prefer to see it converge more quickly. I think that would be fair to say.

We all appreciate that these are big changes. Three years ago, many of these lists were kept in physicians' offices. They weren't kept in a facility at all. As these changes come forward across the country, I don't think anyone is underestimating the change management that individual jurisdictions have had to go through. One can therefore appreciate that it may be difficult to say that we all need to collect it in precisely the same way.

We have seen some renewed interest in understanding the differences in definitions. We would hope that this interest would lead to converging on a decision about the same definitions being used. This way, you could actually compare definitions across the country in the future.

11:55 a.m.

Conservative

Patricia Davidson Conservative Sarnia—Lambton, ON

I'd like to ask about the wait-time benchmark for diagnostic imaging. That was one of the areas that was identified but apparently hadn't been done. Is there any movement there?

11:55 a.m.

Chair, Health Council of Canada

Dr. Jeanne Besner

To the best of my knowledge, no.

11:55 a.m.

Chief Executive Officer, Health Council of Canada

Dr. Donald Juzwishin

As to coming up with a national benchmark, there are hundreds of diagnostic procedures—MRIs, CT scans, PET scanning, X-rays, nuclear medicine. What's needed is to come together with the provinces and territories to talk about establishing benchmarks that can be used throughout the country, though some could perhaps be customized for particular areas. Other jurisdictions like the United Kingdom and the Netherlands have done this, but it requires that people come together and hammer out the details.

11:55 a.m.

Liberal

The Vice-Chair Liberal Lui Temelkovski

Madame Kadis.

May 6th, 2008 / 11:55 a.m.

Liberal

Susan Kadis Liberal Thornhill, ON

Thank you, Mr. Chair, and welcome to all our guests today.

This area is vital to the health of Canadians, particularly in view of the aging population. It becomes much more incumbent upon all of us, and certainly the government, to ensure that the great promise of the health accord is actually realized.

When was the intergovernmental committee disbanded? What was the timeline?

Noon

Chair, Health Council of Canada

Dr. Jeanne Besner

We asked that question a couple of times, and we didn't get a specific date. It is our understanding that it met for around a year, perhaps a bit more. Oh, June 2006, so I guess it met for more than a year.

Noon

Liberal

Susan Kadis Liberal Thornhill, ON

How can we realistically see the promise of this government for guaranteed health wait-times realized if we don't have comparative data? You're saying that it's an ongoing challenge. Is this feasible, or is it more theoretical than practical? If we don't have comparative data from province to province, or if we can't get the data because of the different ways of reporting, is this effort something that's even achievable?

Noon

President and Chief Executive Officer, Canadian Institute for Health Information

Glenda Yeates

We have made significant progress in other areas, so I believe that we can achieve comparable data across the country. It is always a challenge, given the decentralized nature of health care delivery. It will take a lot of energy and work to standardize practices, even from one hospital across the city to another, never mind from one jurisdiction to another. I would not say it is easy; I would say it will take ongoing vigilance. But I think it is something that over time we can achieve.

Noon

Liberal

Susan Kadis Liberal Thornhill, ON

The impression we're getting today from our various witnesses is that there is no current pan-Canadian vision for health care or wait-times by the current government, and that interest and commitment in this area has been flagging, as was shown by the disbanding of the intergovernmental committee. So how can we actually achieve this goal?

We're all concerned that the health care wait-time reductions will not take place in a substantive way soon enough for people to have their health improved. We are concerned about the human suffering and health care costs of not having these reductions take place. Leadership is required. It was there initially. It doesn't seem to be there now, not with the same gusto and commitment.

Noon

Chair, Health Council of Canada

Dr. Jeanne Besner

Obviously there are many, many initiatives and a lot of effort in terms of health care renewal going on across the country. So individual jurisdictions are moving forward—there's no question of that—and progress is being made. I think the point we were trying to make was is there the pan-Canadian vision, the working together, to be clear that we're moving together, without disadvantaging particular jurisdictions and others? I think that's what needs to be recommitted to.

Noon

Liberal

Susan Kadis Liberal Thornhill, ON

When you talk about reviving, it sounds like something is dead or something has gone by the wayside. It's of great concern, I'm sure, to all of us here today, because I think with everybody in every province working in various capacities on these vital areas, we won't reach our objectives if there isn't this overarching commitment by the current federal government, or by a federal government per se.

Noon

Chair, Health Council of Canada

Dr. Jeanne Besner

I would say the commitment has to be made on the part of all governments.

Noon

Liberal

Susan Kadis Liberal Thornhill, ON

There seems to be a roadblock or an impediment to achieving these very important objectives.

Noon

Liberal

The Vice-Chair Liberal Lui Temelkovski

Thank you very much.

I would remind members that we have other panellists here with some special experiences and strengths. Maybe you can move your questions in that direction as well.

Mr. Brown.

Noon

Conservative

Patrick Brown Conservative Barrie, ON

Thank you, Mr. Chair.

I want to touch upon a few things.

I always hear from my local hospital about some of the accomplishments they've had with wait-time reductions. They speak about the local examples and Ontario examples. As an Ontario MP, I'm interested in you sharing with us some of the successes that any of you have witnessed in the province of Ontario specifically with the reduction of wait times.

Noon

President and Chief Executive Officer, Canadian Institute for Health Information

Glenda Yeates

I'll begin and then ask my colleague to speak to that situation.

We have seen, as I mentioned, significantly improved reporting from the province of Ontario in the time period that we've been looking at wait times. Certainly there is much better data. Again, in some of the examples that I raised, the data has stayed relatively constant in terms of the definitions in the province of Ontario. For example, for hip and knee replacements, certainly we do see improvements in those areas. We have seen a tremendous focus in that province, and that's reflected in our reporting.

I'll ask my colleague to expand on that.

12:05 p.m.

Kathleen Morris Consultant, Canadian Institute for Health Information

I think we've seen a number of changes in Ontario over the three-year period when we looked at reported wait times, specifically, as Glenda mentioned, in joint replacements. We've seen similar dramatic decreases in cataract surgery waits as well.

Some of the other areas have been challenging in terms of definitions. I think there have been more stable reported waits in those areas. Those would include cardiac care and cancer surgery.

I think an ongoing challenge in Ontario is wait times for diagnostic imaging, particularly MRI.

12:05 p.m.

Conservative

Patrick Brown Conservative Barrie, ON

One thing I've heard from my local hospital that I found interesting is that from 2004 to today they've gone from a waiting time for an MRI of 54 weeks to seven weeks. Is there any evidence of additional MRI hours being available across Canada or across Ontario? Is that one of the causes of the success you're seeing?