Fraser Institute’s Wait Times Survey For Health Care Services Is ‘Garbage Science’ – Ontario Health Coalition

An Open Message from Natalie Mehra, Executive Director, Ontario Health Coalition

Posted November 29th, 2016 on Niagara At Large

To Members and Supporters –

Kudos to CBC for finally reporting a critical analysis of this Wait Times Survey which you may have heard about in the news last week. An interesting note: We were contacted to do some media interviews about it last week but after I told the media people who contacted me that I was going to talk about the bias in the survey and our concerns with how it is used, they were not interested.
Ontario Health Coalition's executive director Natalie Mehra

Ontario Health Coalition’s executive director Natalie Mehra

Ironically, privatizing hospitals and clinics would not improve wait times. In fact, it would make a host of new problems for patients trying to access care.

Private clinics locate exclusively in the largest cities of the country where there is a “market” of wealthy people large enough for them to make a big profit. They do not serve rural areas, the north and smaller or medium-sized towns.

They charge thousands or even tens of thousands of dollars to patients — on top of billing OHIP (or its equivalent in other provinces). So they often bill twice for the same surgeries or tests. I think this should be considered fraud.

They take away scarce specialists and health professionals from our local public hospitals — and take away the financial resources for them. They only serve “profitable” patients who are not medically complex. If anything goes wrong, the patient is sent to a public hospital. So they bill the public system, and patients on top, serve only the easy profitable patients, take resources away from local public hospitals, and do not pay for their mistakes.

Not a prescription for lower wait times. In fact, its a prescription for fast services for the urban rich and healthy, and worse care for the middle-class, the very sick, the elderly and the poor — and higher costs for everyone. 

Fraser Institute’s wait-time survey: Does it still count if most doctors ignored it?

Only around 20% of doctors responded to questionnaire

By Kelly Crowe, Medical science reporter, CBC News, November 25th, 2016

public-health-care-canada-saveFill out this survey and have a chance to win $2,000 — that’s the annual enticement from the Fraser Institute, an offer made to thousands of doctors whose names appeared on a mailing list.

But it wasn’t tempting enough to get doctors to participate.

No medical oncologists in Saskatchewan, Manitoba or New Brunswick took the bait. 

Zero responses came back from radiation oncologists in New Brunswick or from cardiovascular surgeons in Manitoba.

Not a single plastic surgeon in Prince Edward Island or Newfoundland answered the questionnaire.

Across Canada, just seven per cent of psychiatrists on the list bothered to answer the short survey asking them to estimate how long their patients are waiting for care.

The Fraser Institute is a think-tank that has long advocated for more private-sector options in the Canadian health-care system.

Every year for more than two decades it has published a gloomy report about wait times for health care. This year’s came out on Wednesday.

One in five doctors respond

And every year only around one in five doctors participate, despite that offer of a $2,000 cash draw. In Ontario, less than 15 per cent of all specialists on the mailing list weighed in on the issue of wait times.

The survey — just six questions — doesn’t ask the busy specialists to check their patient records or submit any hard patient data. Doctors are asked only to estimate how long their patients wait to see them, and then wait for diagnostic tests and surgeries.health_accord_feature_new-website

“We’re absolutely clear about the fact that this is a survey,” said Bacchus Barua, one of the authors of the report. “This is not something we can control. We would love it if we had more responses.”

As a way to measure wait times, it’s “preposterous,” said Steven Lewis, a health policy consultant based in Saskatoon. “Why not use a thermometer rather than asking people for their opinion about the weather?”

‘Participation bias’ skews results

“Physicians are inundated with surveys, so they pick and choose,” Lewis said. “It’s also plausible that the most frustrated physicians respond, representing the worst of wait-time experiences.”

It’s called “participation bias”— a well-established fact in statistical science that people who take the time to answer a survey are different than the ones who ignore it.

health-care-save-public“Individuals sometimes complete surveys when they are having particular difficulties with the issue being studied,” said Monique Gignac, a professor at the Dalla Lana School of Public Health at the University of Toronto. In other words, doctors who don’t think wait times are unreasonable might not be motivated to fill out the survey.

“Doctors were also asked to mentally average wait times for what might have been very different conditions and experiences among their patients,” she said. “As a result, the questions may have introduced a number of biases into the study.”

‘To inform patients’

For the Fraser Institute, wait times have held a historic fascination. Its founder, Michael Walker, is cited in this year’s report as the person “responsible for helping navigate the beginnings of wait-time measurement in Canada.”

Back in the late 1980s, Walker was a vocal critic of the Canadian health-care system.

“High-income Canadians effectively are prevented from using their incomes to buy a higher standard of health-care equipment and service,” he wrote in a 1989 report for the Heritage Foundation, a U.S. conservative think-tank.

Three years later, Walker started releasing the annual Canadian wait-time surveys. In the 1992 report, he stated that the Fraser Institute’s objective was “the redirection of public attention to the role of competitive markets in providing for the well-being of Canadians.”

In more recent versions of the report, there is no longer any discussion of policy alternatives, just the facts — as reported by a fraction of the country’s specialists.

Barua said he only has one agenda: “to inform patients about wait times in Canada.”

However, the 2013 survey has been entered as evidence in a constitutional challenge against medicare. The plaintiff, investor-owned Cambie Surgeries Corporation in Vancouver and its CEO, Dr. Brian Day, aim to change the law to allow private payment for medically necessary hospital and physician care. The attorneys general of B.C. and Canada are intervening on behalf of the Canada Health Act and the B.C. Medicare Protection Act.

Health policy analyst Karen Palmer was sitting in on the trial when one of the Fraser Institute’s wait-time study researchers was called as an expert witness for the private clinic.

Palmer, an adjunct professor at Simon Fraser University, said the flaws in the reports methodology were exposed under cross-examination from the lawyers representing the B.C. attorney general.

Provincial data available

“The Fraser Institute methodology is — and I use the word carefully — an abomination,” Lewis said, adding that there’s a better way: use real data. 

“If you tag a referral to the billing code for an office visit, you can easily calculate the time between seeing the GP and getting referred, and the visit to the specialist,” he said.

Barua said the Fraser Institute doesn’t have the resources to do a more detailed survey, and sticking to this format allows them to compare results with the older surveys.

There is another source of data about wait times in Canada. Since 2006, the Canadian Institute for Health Information has used provincial data to track wait times in five priority areas: cancer, heart surgery, joint replacement, sight restoration and diagnostic imaging.

The 2016 report, released in March, concluded that: “Wait times for urgent procedures were at or approaching benchmark targets.”

It found mixed results for some elective procedures, but overall painted a much brighter wait-time picture for Canadians.

“Despite this lack of consistent improvement in wait times for joint replacement and cataract surgery, Canada continues to perform well on median wait times for these procedures when compared internationally,” the report said.

But what about all of those anecdotes, people everyone knows who’ve had horrific waits? Palmer said it’s important to take a close look at those examples.

Health policy analyst Karen Palmer is watching the B.C. court case challenging medicare. She says the Fraser Institute wait-time report was used as expert evidence to support the fight for private health care. (Simon Fraser University)

In most cases, Palmer believes there’s been a miscommunication.

“There’s sometimes a disconnect between the patient’s perceived need and the physician’s professional judgment of the urgency,” Palmer said.

Sometimes patients forgot to book appointments, or family doctors didn’t advocate hard enough to get them seen faster. And Palmer said regional specialists could work together to triage patients into the treatment stream they need, because not everyone needs surgery.

“For those who are legitimately waiting too long, we need to improve how we organize and deliver care,” she said. “Changing how we pay for care to allow private duplicative insurance is not the solution.” 

Palmer said the widespread media coverage of the Fraser Institute’s survey undermines public confidence in the health-care system. “I think it’s unfortunate that it goes out unchallenged every year.”

~ Protecting Public Medicare for All ~

Ontario Health Coalition 15 Gervais Drive, Suite 604 Toronto, ON M3C 1Y8 ohc@sympatico.ca

For more on the Ontario Health Coalition and its advocacy work for protecting publicly funded health care services in Canada, click onhttp://www.ontariohealthcoalition.ca/

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2 responses to “Fraser Institute’s Wait Times Survey For Health Care Services Is ‘Garbage Science’ – Ontario Health Coalition

  1. This is very important information being relayed about skewed studies. I hope The Tyee in B.C. picks it up.

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  2. The big insurance companies will keep trying to privatize health care so we can be stuck with an American style system where only the wealthy get the best treatment. The US is the only first world nation without some form of single payer, except Medicare. Why do you think there is such a right wing uproar over “Obamacare”? Insurance companies don’t want to insure people who might cost them money, like those with pre existing conditions. That might reduce their profits slightly from X+Y billions to X billions. Poor dears! For 3 consecutive years, 2006 to 2009, insurance company profits rose over 56%….not 56% profit but 56%$ INCREASE in profits. (*Huffington Post). They have been taught that it is Socialist, AKA Communist, god forbid! Hilarious since I saw one obese American sitting on his walker with a sign saying, “Socialist Obama get your hands off my Medicare” ??????
    There’s money to be had….BIG money. It has NOTHING to do with “better” or “more efficient” service, just MONEY. It will also take doctors out of the system, especially specialists. The government would love to divert those health care costs, which are far lower per capita than in the US, to their own pet projects….their feeding troughs, salaries and personal expense accounts.

    If I lived in the US I would be bankrupt by now due to health problems that were beyond my control (no I don’t weigh 300 lbs or drink or smoke). That would have meant the inability for me to work for about 20 years and leeching off the taxpayers for either welfare or disability. Being restored to health and able to return to work, I was able to contribute to society AND….pay taxes that contribute to the care of everyone. Elements in our government and the insurance industry have been perpetually chipping away at our health care system so it is already a shadow of its former self. That’s why you hear more complaints recently. Staff do what they can with what they’re given.

    I suggest watching a You Tube – Kucinich slams Right Wing Health Care “Expert” – http://youtu.be/kQuJ_oesDrA. The “expert” has no answers and the jig is up.

    A healthy society is a productive one. They know that but don’t care. Did I already mention, all they care about is money? (Sarcasm). We need to wake up and support the Health Coalition. Once you need care and find out it’s gone, it will be too late.

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