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Wednesday, June 30, 2004

Health Services Access Survey

2003

Canadians have clearly identified waiting times as their number one barrier in accessing specialized health-care services, according to the 2003 Health Services Access Survey (HSAS). The survey explored access to three types of specialized care: visits to specialists, non-emergency surgeries and diagnostic tests, as well as access to first contact services.

Between 13% (non-emergency surgery) and 21% (specialist visits) of people who accessed specialized care reported that they had encountered difficulties. The majority of those experiencing difficulties reported that the main barrier was that they had to wait too long for care. This finding on waiting times is consistent with previous studies regarding access to health care.

Overall, the survey found that the vast majority of individuals who accessed any of the three specialized services waited three months or less. Individuals who waited to visit a specialist or get a diagnostic test were more likely to get care within one month than those waiting for non-emergency surgery.

The 2003 HSAS provides comparable self-reported waiting time data at the provincial level. The results indicate that there was some variation in waiting times across provinces: the proportion of individuals who waited longer than 3 months for a specialist visit ranged from a low of 8% in Prince Edward Island to a high of 21% in Newfoundland and Labrador. Conversely, Newfoundland and Labrador had the lowest rate (10%) of individuals waiting longer than three months for non-emergency surgery. The rate was highest in Saskatchewan (29%).

While most people deemed their waits acceptable, there were individuals in all provinces who considered them unacceptable. Among those who had waited for a specialist visit, 29% reported that they felt the time they waited was unacceptable. These people had waited about four times as long as those who said their waits were acceptable.


Note to readers

This release is based on the report Access to Health Care Services in Canada, 2003, available today.

This report provides results from the 2003 Health Services Access Survey (HSAS), which focused on access to specialized services and first contact services. The specialized services include visits to a specialist for a new illness or condition, non-emergency surgeries and selected diagnostic tests. The information is provided at the provincial level, thus allowing for a comprehensive assessment of access to care across Canada.

The 2003 HSAS was conducted as a supplement to cycle 2.1 of the Canadian Community Health Survey. The total sample size was about 32,000 individuals aged 15 and over living in a private household in the 10 provinces.

Comparisons to the 2001 HSAS results should be made with caution because of differences in data collection method.


Less than 20% of individuals who waited for a specialized service said that waiting had an impact on their life. Most reported the waiting caused worry, anxiety and stress. Half reported they had to cope with pain.

Difficulties accessing specialized services

The survey showed that of the more than 2.9 million individuals who visited a medical specialist in 2003 for a new illness or condition, just over 600,000, or about 21%, reported experiencing a difficulty.

The results varied across provinces. For example, data showed that 29% of people in Newfoundland and Labrador encountered a barrier when they visited a specialist the year preceding the survey, the highest proportion. This was twice the rate of 14% in Prince Edward Island.

Approximately 13% of those who accessed non-emergency surgery (about 200,000) reported that they had experienced difficulties. The provincial results ranged from a low of 9% in Ontario and Alberta to a high of 20% in British Columbia.

As well, 300,000, or 16%, of the 1.9 million people who accessed diagnostic tests indicated that they experienced difficulties.

Over 60% of the people who experienced difficulties in visiting a specialist or in accessing non-emergency surgery reported that it was due to long waits. Long waits were reported by 55% of those who faced problems getting a diagnostic test.

Waiting times generally three months or less for specialized services

Overall, the survey found that the vast majority of individuals who accessed any of the three specialized services waited three months or less. Individuals who waited to visit a specialist or get a diagnostic test were more likely to get care within one month than those waiting for non-emergency surgery.

Among those who visited a medical specialist, 48% waited less than one month. The results varied from a low of 40% in Newfoundland and Labrador to a high of 54% in Québec.

At the other end of the spectrum, 11% of people reported that they waited longer than three months to visit a specialist. This ranged from a low of 8% in Prince Edward Island to a high of 21% in Newfoundland and Labrador.

In the case of non-emergency surgery, about 41% of individuals who waited did so for less than one month. Provincially, the results ranged from 34% in Québec to a high of 50% in Newfoundland and Labrador.

However, about 17% of people reported that they waited longer than three months for non-emergency surgery. The rate was significantly lower in Newfoundland and Labrador at 10%, and significantly higher in Saskatchewan at 29%.

Distribution of waiting times for non-emergency surgeries
  Less than 1 month 1 to 3 months Longer than 3 months
  %
Newfoundland and Labrador 50 40 10E*
Prince Edward Island 45 45 ..
Nova Scotia 39 37 24E
New Brunswick 41 40 19E
Québec 34 51* 15E
Ontario 40 44 16
Manitoba 41 46 13E
Saskatchewan 37 35 29*
Alberta 49 38 13E
British Columbia 43 33* 24
Canada 41 42 17
Notes: Based on population reporting waiting times for non-emergency surgeries accessed in past 12 months.
Analysis excludes non-response ("I don't know", "not stated", and "refusal").
EInterpret with caution (high sampling variability).
..Data not provided due to extreme sampling variability or small sample size.
*Statistically significant difference between Canada and provincial-level estimates (p < 0.05).

Overall, the majority (58%) of individuals who waited for selected diagnostic tests did so for less than one month. Approximately 12% reported that they had waited longer than three months. Despite some provincial variations in the proportion that waited more than three months, none of the provincial rates was statistically different from the national rate.

Nationally, the median waiting time to visit a specialist was four weeks. This means that half of people waited longer, and half waited less. The median wait for non-emergency surgery was 4.3 weeks, and for diagnostic tests, three weeks.

Acceptability of waiting times

Individuals who had waited for specialized services were also asked whether they considered their waiting times acceptable. For the first time, information regarding the acceptability of waiting times is also available by province.

Percentage of Canadians who considered waiting time for specialized services unacceptable
  Specialist visits Non-emergency surgeries Diagnostic tests
  %
Newfoundland and Labrador 33 16E 24E
Prince Edward Island 19E* .. 20E
Nova Scotia 29 19E 21E
New Brunswick 22* 18E 15E
Québec 22* 17E 16E
Ontario 32 14 21
Manitoba 29 13E 30*
Saskatchewan 24 21E 19E
Alberta 29 15E 28E
British Columbia 32 25* 21
Canada 29 17 21
Notes: Based on population accessing these services in past 12 months.
Analysis excludes non-response ("I don't know", "not stated", and "refusal").
EInterpret with caution (high sampling variability).
..Data not provided due to extreme sampling variability or small sample size.
*Statistically significant difference between Canada and provincial-level estimates (p < 0.05).

Among those who had waited to visit a specialist, 29% reported unacceptable waits. Provincially, this ranged from a low of 19% in Prince Edward Island to a high of 33% in Newfoundland and Labrador.

Among those who had waited for non-emergency surgery, 17% considered their waiting time unacceptable. The range provincially went from 13% in Manitoba to a high of 25% in British Columbia.

About one in every five individuals who waited for a diagnostic test reported that their waiting time was unacceptable. The provincial rates varied from a low of 15% in New Brunswick to a high of 30% in Manitoba.

A number of factors have an impact on whether individuals deem their waiting times unacceptable. These include the length of the wait, the impact on their life and their expectations about waiting for care.

Those reporting unacceptable waiting times generally had longer waits and were more likely than people with acceptable waiting times to feel that the wait had an impact on their life.

For example, among people who waited to see a specialist, those who said their waiting time was unacceptable waited 8.6 weeks. This was four times the duration of 2.0 weeks among people who considered their wait acceptable.

Consequences of waiting: Worry, stress and pain

Canadians reported two major consequences of long waits: the worry, stress and anxiety caused by the delays, and pain.

However, there were many others, such as problems with activities of daily living, deterioration of health, increased use of over-the-counter drugs, loss of work and loss of income.

Overall, about one-fifth (19%) of people who waited to visit a specialist reported being affected by the delay in one form or another. The rate ranged from a low of 11% in Prince Edward Island to a high of 22% in Newfoundland and Labrador.

About 10% of individuals who had waited for non-emergency surgery reported being affected, as did 14% of those who waited for a diagnostic test.

Nearly three-quarters (72%) of people who said they were affected by waiting for a specialist reported that they experienced worry, anxiety and stress. So did roughly 60% of those who were affected by waiting for non-emergency surgery and diagnostic tests.

However, more than one-half of the people who said they were affected by waiting for non-emergency surgery and diagnostic tests reported suffering pain because of the delay.

More than one-quarter of people who said they were affected by waiting for any of the three services reported that they had problems with activities of daily living.

The report also examines access to first contact services, including routine care, immediate care for a minor health problem and seeking health information and advice.

Definitions, data sources and methods: survey number 3226.

The report Access to health care services in Canada, 2003 (82-575-XIE, free) is now available on our website. From the Our products and services page, under Browse our Internet publications, choose Free, then Health.

To enquire about the concepts, methods or data quality of this release, contact Claudia Sanmartin (613-951-6059; fax: 613-951-3959; claudia.sanmartin@statcan.gc.ca) or Jean-Marie Berthelot (613-951-3760; fax: 613-951-3959; berthel@statcan.gc.ca), Health Analysis and Measurement Group.

For more information regarding access to the 2003 HSAS data, contact Mario Bédard (613-951-8933; fax: 613-951-4198; mario.bedard@statcan.gc.ca), Health Statistics Division.



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