Wait time guarantees not likely to reduce waits for joint replacement surgery in Ontario

    System needs to examine increasing surgical capacity or diverting
    patients: study

    LONDON, ON, Oct. 30 /CNW/ - Significant increases in surgical capacity or
diverting patients to other jurisdictions are the best ways to deal with
excessive wait times for hip and knee replacement surgery - a leading symbol
of underfunding in Canada's healthcare system.
    Politically popular strategies, such as wait time guarantees, are not
likely to have much impact, according to a new study. Instead, the study
suggests standardized methods of patient prioritization will ensure that the
most urgent patients receive surgery first. Wait-list sharing among surgeons
will also help to reduce variation in wait times for patients of similar
clinical urgency.
    The study, "An Evaluation of Strategies to Reduce Waiting Times for Joint
Replacement in Ontario," published in the November issue of Medical Care,
examines the effectiveness of a number of strategies to reduce wait times for
this type of surgery. It compared reducing demand for surgery and increasing
the number of surgeries performed, patient prioritization, wait time
guarantees and provincewide, instead of regional, wait lists.
    The study is authored by Lauren Cipriano, Massachusetts General Hospital;
Bert Chesworth, Schulich School of Medicine & Dentistry, The University of
Western Ontario; Chris Anderson, Cornell University and Greg Zaric, Richard
Ivey School of Business, The University of Western Ontario. It uses a computer
simulation model, developed by the researchers, to evaluate the strategies.
    Their results show that even if 14 per cent more surgeries are provided
each year (twice the historical rate), it will take almost a decade to ensure
that 90 per cent of patients receive surgery within recommended wait times. A
wait time guarantee for all patients shortens waits for low-priority patients,
but makes high-priority patients wait longer.
    "Waiting time guarantees do not, on their own, reduce waiting times. They
only shuffle the order in which patients are seen, which benefits some
patients at the expense of others," said Zaric, Canada Research Chair in
Health Care Management Science and Associate Professor at The University of
Western Ontario's Richard Ivey School of Business.
    "In order for the majority of patients to receive their surgery within
clinically acceptable times there must either be substantial diversion to
jurisdictions with excess capacity or growth in Ontario's capacity at a much
higher level than has been observed historically," said Zaric.
    Long waiting times for joint replacement surgery are a problem in many
OECD countries (Organization for Economic Co-operation and Development). Many
potential solutions have been tried but there is no consensus.
    In Ontario, in 2005, the median wait time was five months for total hip
replacement and eight months for total knee replacement. Demand for joint
replacement surgery is likely to increase due to changing demographics,
increasing rates of obesity and arthritis, and an overall increase in people's
willingness to undergo surgery.
    Waiting times for hip and knee replacement were identified by Canada's
First Ministers as a priority area, along with cancer, heart, and sight
restoration surgeries.
    For more information, please contact Greg Zaric at 519-661-3415 or

    About the Richard Ivey School of Business, The University of
    Western Ontario

    The Richard Ivey School of Business at The University of Western Ontario
(www.ivey.ca) offers undergraduate (HBA) and graduate (MBA, Executive MBA and
PhD) degree programs in addition to non-degree Executive Development programs.
Ivey has campuses in London (Ontario), Toronto, and Hong Kong. Ivey recently
redesigned its curriculum to focus on Cross-Enterprise Leadership - a holistic
issues-based approach to management education that meets the demands of
today's complex global business world.

For further information:

For further information: Dawn Milne, Communications Specialist, Richard
Ivey School of Business, (519) 850-2536, dmilne@ivey.ca

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