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https://www.cihi.ca/en/health-system-performance/access-and-wait-times We don't have a free market to speed up competitive information in Canada, so it's up to a public of concerned citizens to monitor healthcare statistics and put pressure on providers to provide coverage, at quality, for a decent cost. And yet, I never hear people speak about CIHI - Canadian Institute for Health Information.

1) The Harper government extended support for the Canadian Institute for Health Information. It's a good source. https://www.cihi.ca/en 2) Yes, these are striking stories and I don't usually defend Canadian the overall performance of our system on its own. 3) I should say your approach is wrong. Look at the data. 4) Newspapers are a good source. Look, I am not saying that the system is good. I strongly feel that Canadian attitudes towards government services reflect a tradition of peasants accepting baubles from the Family Compact. The place to start, to my view, is an informed view of where we are with costs and services. If you bring emotionalism into it, then you will allow a whole sector of people who somehow thing that our health system is an example of patriotism. It's not. Healthcare and Immigration (the subject of the thread, to get back to it) are systems. There is always an emotional component because we are not robots and want the best for ourselves and those close to us, but we should be demanding better quality and less expensive at all times.

Not sure if you were around then, but at one point I tried to initiate a project wherein MLW members would try to agree to gather statistics on healthcare and even contacted CIHI about getting their help. The response was so underwhelming that I gave up. And this is on a forum where people actively discuss such things, so in that sense it's not surprising that the public doesn't pay attention. At that time, I went extensively through CIHI's site and read many of their reports. The Sun article you linked is typical of their reporting: This really doesn't give enough information. I suspect if you go to the actual report, there is some improvement in some places along with a whole mess of footnotes at the bottom explaining why Eastern Ontario hospitals weren't included yet, or whether queue times for Saskatchewan include ultrasounds etc. etc. etc. This project is 5 years down the line and they still don't even have consistent reporting standards. Can we discuss inertia ? Imagine a corporation not being able to report its performance to stakeholders for five years. Heads would roll. CIHI is a well-intentioned institution, but they are a product of their environment: slow, complacent and too complicated to understand. This is what one-tier healthcare gives its stakeholders, i.e. us. The board of directors of CIHI, is a pile of people who came from provincial health ministries and general students of the system as it exists. I'm not really saying that they do a bad job of recruiting, specifically, but that management is generally not challenged - and that the entire system is managed with politics at the very top of the pyramid. So recruiting is one example, but a challenge from somewhere else would be helpful. They are not adequately motivated, as evidenced by the slow progress and debacles like eHealth. These problems are not so unsolvable: in my mind, they're symptoms of a monopolistic and uncaring system. When I deal with the healtcare establishment, I feel like I'm dealing with Rogers or Bell Canada - but worse as there's only one option not two. They certainly are contradictory. ER wait times aren't meeting target, and you can't find trend data either: http://edrs.waittimes.net/en/Data.aspx?LHIN=7&city=&pc=&dist=0&hosptID=0&str=&view=0&period=23&expand=0 Well, that's good to hear. I would favour eHealth Manitoba taking over eHealth Ontario in a heartbeat.

Below is my do-it-yourself comparison of report cards for Canada's healthcare system (survey wait times). Basically it says whether the province met the target 75% of the time for this year, and last year. So y(n) means it MET target this year, but not last year. So this is your health system. Proud of it ? If so, why ? Because it's better than the US system ? If that's your benchmark for success, then you can pretty much guarantee that the system will deteriorate until it's just slightly better than that system. Meanwhile, here we have 15/40 or 37.5% of indexes BELOW the benchmark, which is already quite loose at 75% of a standard. How did we do last year ? The exact same. One thing has improved - we had 3 areas with ? last year, and this year we're down to 1. However, you can be sure that that ? will turn to an 'n'. Beyond the stats themselves, the fact that I had to cobble them together myself into this pathetic display shows that there's not enough demand for good performance statistics right now. And, in an eerie premonition of what may come, I believe that ER stats have now been declared RESTRICTED ACCESS. That's right - the government will now opt to not publish performance statistics for your system. But, it's better than the US right ? Right ? We'd better figure that out soon, because once the government stops publishing performance statistics, then stops reporting costs. (I realize that this table is pretty damned awful, however if somebody can tell me how to paste a table onto this site, please do so and I will happily oblige next time.) Note: Coronary Bypass times are missing for 2010 and Fracture Repair surgery wasn't in the 2009 table. Sources: http://secure.cihi.ca/cihiweb/products/wait_times_tables_aib_e.pdf http://secure.cihi.ca/cihiweb/products/wait_times_tables_2010_e.pdf This table answers the question: Did the province report 75% of patients receiving treatment withing Time target for 2010 ? (with 2009 performance in brackets) .......|Hip.Replacement|....Knee ....|...Cataract.....|....Cancer.....| .......|.....Surgery.........|..Surgery...|.....Surgery....|..Treatment..| .......|..within.26.wks..|wthn26.wk|(within.26.wks|within.4.wks| -------+-------+-------+-------+-------+-------+-------+-------+-------+. N.L....|........n(y).......|.........n(n).....|........y(n).......|........y(y).....| -------+-------+-------+-------+-------+-------+-------+-------+-------+. P.E.I..|........y(n).......|.........n(y).....|........y(n).......|........y(y).....| -------+-------+-------+-------+-------+-------+-------+-------+-------+. N.S....|........n(n)......|..........n(n).....|........n(y)......|........n(?).....| -------+-------+-------+-------+-------+-------+-------+-------+-------+. N.B....|........y(n)......|.........n(n)......|.......y(n).......|........y(y).....| -------+-------+-------+-------+-------+-------+-------+-------+-------+. Que...|........y(y).......|.........y(y).....|........?(?).......|.......y(y)......| -------+-------+-------+-------+-------+-------+-------+-------+-------+. Ont....|........y(y)......|..........y(y).....|........y(y).......|........y(y).....| -------+-------+-------+-------+-------+-------+-------+-------+-------+. Man...|........n(y)......|.........n(n).....|........y(y).......|........y(y).....| -------+-------+-------+-------+-------+-------+-------+-------+-------+. Sask..|........n(n)......|.........n(n).....|........y(y).......|........y(y).....| -------+-------+-------+-------+-------+-------+-------+-------+-------+. Alta...|........y(y).......|..........n(n).....|........n(n)......|.......n(?).....| -------+-------+-------+-------+-------+-------+-------+-------+-------+. B.C....|........y(y).......|..........y(n).....|........y(y)......|.......y(y).....| -------+-------+-------+-------+-------+-------+-------+-------+-------+.

The Canadian Institute for Health Information. They are supposed to be our source for healthcare information. I would ask the CIHI to provide easy to read, frequent, and independently audited healthcare stats for public consumption, and for governments to provide access to an online forum (non-anonymous) where individuals can discuss how healthcare is working. Responses would be provided by fellow citizen/patients, and stakeholders (government, administration, various labour resources and associations)

Because the funding agreement will be expiring soon, and costs can't continue to grow faster than inflation. If we're already making "either/or" decisions with regards to other spending - and defense is just one example - then doesn't that mean we need to look more closely at ways to stop healthcare spending increases ? We also need to talk about paying for services, not just getting services. It would be better if we had a common understanding of where the increases are going and what we can do about that. In order to have that understanding, we have to have productive dialogue. The Federal government oversees national standards and can tie transfer payments to better practices in terms of cost control and accountability. --------------------- If we want to have a productive dialogue, it is essential to focus on the facts IMO. For facts, there is no better source in Canada than the Canadian Institute for Health Information. Read THIS: CIHI Healthcare Cost Drivers over the past decade

The main problem with this problem is that we have no way to frame it for the public. The healthcare discussion is very complex, and it happens only in terms of 'reports' and 'press releases' by interested parties, including the health ministries themselves. We don't have access to the data, so we can only parrot information that comes from those interested parties. But, the good news is that Canadians have begun to get so frustrated that they're actually demanding results. For example, it actually looks like *both* sides of the debate here on MLW are concerned with costs. That means we have a consensus ! (Step 1) Now, we would only need an organization to start a pilot project to achieve a goal. If we had an independent and trustworthy organization that could monitor the pilot project, and provide reliable performance reports, and some organizations to try it - then we would we would have a proposed solution ! (Step 2) There is currently one body that provides national healthcare statistics, the Canadian Institute for Health Information. Their reports are useful, but they don't report on everything. My feeling is that August1991 and the pro-private health care are right, and that the time has come for us to engage the private sector. However, this action will be useless unless Canadians are better equipped to determine whether these projects are successful or not. I think that it would be amazing if someone initiate a citizen's interest group that partnered with CIHI, a private provider, and a provincial health ministry to propose such a pilot project. (And now... the fantasy part.... ) A web such as MLW would be a fertile ground for supplying a good cross section of interested citizens for the project.

Recently, Ontarians were alerted to a newsworthy story about something called eHealth Ontario, and it's greedy consultants overbilling the province for doing not much of anything. I expect that those stories were the first time most of us had heard of eHealth Ontario or its predecessor 'Smart Systems for Health'. I have been blogging on this topic for years now, and I maintain that the problem is public apathy, married with media that is not suited to reviewing complex issues of government management. Ontarians, by their lack of interest in these matters, have indirectly allowed the Ontario government to continue in this manner for years. We still don't know what is going on, other than some tidbits of outrage that are lobbed out. Wait times for health care should be one of the most well known issues in the public eye, but it isn't. The Province has spent years managing the issue via press releases. And if we're hoping for media to lead the public on this issue, I hail back to an apt phrase I heard recently: journalists are good at reporting revolution, not evolution. The mismanagement of wait times has been happening for years, without any degree of alarm from our journalists. But now, a consultant billing thousands of dollars per day, then asking for tea money is news. Let's review: McGuinty promised standardized wait times in 2003 ! The Record Now let's look at the government's numerous own press releases on the topic since 2004: Ontario Wait Times News Releases Recently, the Ontario government started getting some traction on reporting and reducing wait times, after spending some unknown large amount of money on the problem. It seems that the situation has improved, however it's not clear. The wait times on the Ontario MOH websites: Ontario ER Wait Times Ontario Surgery Wait Times However, these numbers are poorly explained, and there is no independent verification whatsoever. That amounts to self-reporting, ie. telling your boss how well you're doing at your job. Ontario seems to have had improved wait times, however, there is no trend reporting (some of that is provided at the Canadian Institute for Health Information website - a quasi-independent watch group - here: CIHI Wait Times Here's an example of the inconsistency of reporting. How are wait times measured ? http://www.health.gov.on.ca/transformation.../wt_data.html#2 Now, go to an individual report and you will see a different definition: WaitTimes.net And there is at least one other definition. But besides the inconsistent definitions, there is the fact that there are still a significant number of non-reporting hospitals, and it's not clear how they average their numbers in the first place. Oh, and when you Google for Ontario Wait Times, you get THIS first, describing a "new" waiting list from 2005: Medical News Site It's scandalous and we're to blame for accepting this situation. Mike Harris was basically chased out of Ontario for trying to change things without enough planning or thought. In the case of water testing, it resulted in deaths in Ontario. But Harris' destructive methods were replaced by a persistent and complacent acceptance of the status quo. We need to come up with a new way to focus public attention on the terrible mismanagement and non-reporting that is happening in healthcare. If we don't care about such things (except for the fun scandals) then our media won't care either. I urge people to talk about these issues, to blog about them and to email [email protected].

TB, Yes, that happens but every system fails. It's unrealistic to demand perfection. That sure isn't reason enough to reject a private inclusion in the system. Not at all. I'm suggesting that the government set all rates and pay out as happens today, but with more private management of the system overall. Or at least, some kind of new arm's length relationship between government and management. That ability to throw out a government if it screws up is a false ability. The public doesn't have much choice from one government to the next. The system continues much as it always does. The system should be effectively the same as it has been. Because it worked for you then the system is good ? That's not a high enough bar. The fact that no can ultimately say how we're doing is proof that the system needs rework. There is no method for improvement, and the public is disconnected from the process. If so, then I'd love to see that happen. Explain to me how it would happen. My experience in business says that when things reach this level of complexity it's much easier to start fresh. This is what GM did with Saturn. The issue of inadequate wages is kind of a side issue. The issue should be about delivering better health care. That should be the priority. If a janitor gets hired along the way who is not a union member then so be it. It sounds easy but it's not. Like I say, something new needs to be done. The electorate is incapable of this now. There are some ways that this could improve with a private provider. Maybe just the fact that it will be watched more closely will help things. Again, I don't know why you doubt that. There isn't enough information for us to say. All we have is stakeholder associations telling us "our members are swamped". I don't support purely private healthcare. I think 2-tiered healthcare would be a disaster if implemented in our current environment of ignorance. But we need to do something new, and create awareness around the issues and some private delivery would probably help this. Why do we have to pay more money ? Where are the extra costs ? There are 'studies' on this but not enough collective discussion of how to fix things. If the reasons were monitored and presented to us as raw data then we wouldn't have to rely on interlopers to tell us what's happening. This is the mandate of the CIHI currently, however they only produce 'reports' not ongoing graphs of healthcare performance. Consumers need to start acting like customers and shareholders and demanding better.