Friday, October 06, 2006

Entirely expected

The Globe and Mail reports that a narrow focus on a few types of wait times may be leading to increased waiting lists for other types of surgery not included in the Cons' proposed guarantee:
Doctors across Canada who perform hysterectomies, colonoscopies and gallbladder surgeries say the operations are being delayed as politicians channel resources into the five waiting-time priorities established in a federal-provincial deal crafted two years ago.

Specialists who do not provide cancer care, heart operations, cataract removal, hip and knee replacement, and diagnostic imaging — the five priorities spelled out in the 2004 accord — say they watch resources flow to those areas while their own patient queues grow longer. The situation, which calls into question the strategy adopted by successive federal governments in their effort to cut lineups, is of such concern that it was raised at a meeting of the Royal College of Physicians and Surgeons two weeks ago.

And because there is so much anecdotal evidence to support the complaints but no hard data, the problem is a major focus of an on-line study launched this week by the Canadian Medical Association...

The original proposition was that the provinces would begin by targeting the five high-visibility areas and then gradually increase the number of procedures that must be treated within clinically acceptable time frames. But that hasn't happened, said Andrew Padmos, chief executive officer of the Royal College of Physicians and Surgeons.

“The funds made available and the process to deal with them has not been able to address all of the backlog in those specialty areas that were selected and it's certainly made things worse for the other areas in general,” Dr. Padmos said.

More than that, because hospitals and health districts are given money for volume in the five target areas, there is justification and encouragement to shift resources — such as operating rooms, anesthetists and operating-room nurses — in those directions because it will bring in new and additional funding.

“So it's a bit of a double whammy because everything else is seen as a cost whereas these five areas can be construed as revenue producing,” Dr. Padmos said.
It's not clear yet whether the problem is truly a national one, or whether some provinces or regions have properly prioritized general patient care over the Cons' arbitrary targets. But there's now at least anecdotal evidence showing an effect even before any guarantee has been formally implemented, and it may not be long before more substantive data is available as well.

Mind you, Tony Clement has never been one to accept the prospect that evidence should trump his party's plans. But now that the predictable (and predicted) effects of a narrow focus are already materializing, it may not be long before the wait-times guarantee not only drops out of the Cons' main priorities, but drops off the radar entirely in favour of more thorough coverage.

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