Hunter Prize: Modernizing access to specialized treatment is critical to curbing health-care wait times

Canada's health system needs 21st-century tools to deal with its wait times crisis
Medical staff work at a computer terminal as they prepare for the opening of the COVID-19 Assessment Centre at Brewer Park Arena in Ottawa, during a media tour on Friday, March 13, 2020. Justin Tang/The Canadian Press.

The Hub’s first annual Hunter Prize for Public Policy, generously supported by the Hunter Family Foundation, focused on solving the problem of long wait times in Canada’s health-care system. A diverse group of ten finalists have been chosen from nearly 200 entries, with the finalists and winners chosen by an esteemed panel of judges, including Robert Asselin, Dr. Adam Kassam, Amanda Lang, Karen Restoule, and Trevor Tombe. The Hub is pleased to run essays from each finalist this week that lay out their plans to help solve this persistent policy problem. The winners of the first-ever Hunter Prize for Public Policy will be announced on Friday, September 29.

“Problems cannot be solved with the same mindset that created them.”

– Albert Einstein

Canada’s health-care system, a source of national pride, has long grappled with extensive wait times for specialist care and medically necessary elective surgeries. Despite substantial health-care spending and a commitment to universality, Canadian patients continue to experience the longest wait times among commonwealth and OECD countries—waits made longer by the COVID-19 pandemic. The consequences of these protracted wait times are far-reaching, negatively impacting patients’ quality of life, psychological well-being, financial stability, and even the progression of treatable conditions into chronic illnesses or disabilities. Urgent policy action is needed to address this crisis.

We can’t continue to use 20th-century technology to manage wait times. A modern and coordinated approach to tackling fundamental problems is required. Two core issues stand out as critical drivers limiting the reduction of wait times: outdated referral systems and a lack of coordinated health data. 

The current referral system in Canada is plagued by fragmentation, variability, and inefficiency. Patients navigating the health-care landscape find themselves lost in a maze of referrals and waitlists. The referral process lacks standardization with primary care providers and specialists operating in isolation, leading to substantial disparities in wait times across medical specialties and geographic regions. The reliance on obsolete communication methods like fax contributes to breakdowns in the referral and booking processes, resulting in significant delays and disruptions in patient care.

Furthermore, Canada’s health-care data infrastructure is in dire need of modernization. The absence of standardized data definitions and common reporting practices has hindered accurate measurement and monitoring of wait times, impeding the ability to make informed decisions, allocate resources, and implement targeted interventions. Other countries have shown that improved wait times correlate with transparent and standardized data reporting. Yet, Canada’s approach has fallen short, leaving decisionmakers without the necessary information to address bottlenecks effectively.

To address these pressing issues, we need to shift to a pan-Canadian mindset: the creation of a transformative institute to Modernize Access to Specialized Treatment (MAST) is recommended to capitalize on modern technology, spread and scale international best practices, and foster interprovincial collaboration. This independent institute would have a clear mandate to modernize, measure, and monitor health-care access. As an equalizer and capacity builder, it could facilitate the implementation of evidence-based practices to reduce wait times. Critically, it would also serve as a regulator, providing legislative, policy, and financial resources to hold Canadian health systems accountable.

Coordinated electronic referrals—A critical need

The MAST Institute’s role in facilitating the streamlined implementation of single-entry referral models is crucial to ensuring patients are matched with the right specialist in a timely manner. By working with provinces and territories to transition to this evidence-based model that centralizes referrals and optimizes patient flow, health-care systems can reduce wait times while improving transparency, administration, and patient and provider outcomes and satisfaction. The elimination of paper-based fax referrals would also enhance communication and reduce the chances of referrals getting lost in the system. This centralized approach has broad stakeholder support and requires system-level leadership to accelerate its adoption across all provinces and specialties.

Addressing deficiencies in digital health data systems

A MAST Institute would tackle Canada’s data deficit head-on by establishing common data governance, reporting, and interoperability standards across all specialties and regions. Drawing inspiration from successful international models, such as Healthcare Improvement Scotland, the institute would empower provinces to modernize their data infrastructure and promote the transparent reporting of wait times data that accurately represents the patient journey across provinces, specialties, and providers. This would involve establishing national reporting standards with common definitions and synthesis of critical information to create a cohesive digital ecosystem encompassing scheduling, referral management, patient portals, electronic medical records, and wait time reporting. This standardized approach would enable provinces and territories to facilitate evidence-based decision-making and targeted policy interventions. 

Fundamentally, the success of a MAST Institute’s initiatives hinges on a participatory and transparent co-design approach. Engaging key stakeholders, including decision-makers, health-care providers, and patients across Canada, is essential to ensure that the implemented solutions balance local needs, patient privacy, transparency, and rapid data turnaround. Fortunately, most providers and patients are already eager for such an approach. 

A path forward: Accountable, feasible, and cost-effective leadership

The problem isn’t solely a matter of how to provide faster care—it’s a systemic issue rooted in the lack of a coordinated approach. Canadian health-care data infrastructure is in dire need of centralized leadership and policies to streamline the patient journey and reduce wait times. While technical knowledge and evidence-informed pilots already exist in Canada, system-level reform requires national leadership to address resistance to change and lack of political will in a time of fiscal restraint.  

The establishment of an institute to Modernize Access to Specialized Treatment (MAST) could be the critical pan-Canadian mindset shift needed to tackle the fragmented individualized approach fostered by the troubled romance between provincial healthcare and Canadian federalism. The proposed MAST Institute is rooted in a pragmatic approach and alignment with existing federal financial commitments. By consolidating resources and expertise from the Canadian Institute for Health Information and Canada Health Infoway, the Institute’s establishment can action recommendations from past federal reports for a more focused mandate without significantly increasing financial burdens. 

Furthermore, the Institute would give needed purpose, structure, and accountability to the recent $46.2 billion Federal agreement prioritizing critical deficiencies in digital health data systems. The MAST institute would leverage this commitment, bolstered by fiscal accountability tools akin to early learning and child care bilateral agreements, ensuring provinces’ adherence to necessary systemic enhancements. 

The approach offers both carrot and stick to drag Canadian health data systems into the 21st century: modern standardized and interoperable digital infrastructure and referral processes, coupled with mandate-driven federal funding agreements to hold provinces accountable for measurable wait time reduction. The time is now because Canadians don’t have any longer to wait.

Sign up for FREE and receive The Hub’s weekly email newsletter.

You'll get our weekly newsletter featuring The Hub’s thought-provoking insights and analysis of Canadian policy issues and in-depth interviews with the world’s sharpest minds and thinkers.