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

Oct 31, 2008

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.

Source: University of Western Ontario

Explore further: What to do with kidneys from older deceased donors?

add to favorites email to friend print save as pdf

Related Stories

How rocket science may improve kidney dialysis

Mar 17, 2015

A team of researchers in the United Kingdom has found a way to redesign an artificial connection between an artery and vein, known as an Arterio-Venous Fistulae, which surgeons form in the arms of people ...

The year ahead in science

Jan 05, 2015

Some serious groundwork has been laid. Some amazing instruments are turning on. Some incredible destinations are in sight. If you ask us, 2015 is going to be an awesome year in science.

Recommended for you

Obese British man in court fight for surgery

Jul 11, 2011

A British man weighing 22 stone (139 kilograms, 306 pounds) launched a court appeal Monday against a decision to refuse him state-funded obesity surgery because he is not fat enough.

2008 crisis spurred rise in suicides in Europe

Jul 08, 2011

The financial crisis that began to hit Europe in mid-2008 reversed a steady, years-long fall in suicides among people of working age, according to a letter published on Friday by The Lancet.

New food labels dished up to keep Europe healthy

Jul 06, 2011

A groundbreaking deal on compulsory new food labels Wednesday is set to give Europeans clear information on the nutritional and energy content of products, as well as country of origin.

Overweight men have poorer sperm count

Jul 04, 2011

Overweight or obese men, like their female counterparts, have a lower chance of becoming a parent, according to a comparison of sperm quality presented at a European fertility meeting Monday.

User comments : 0

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.