Methodology of Fraser Institute’s patient wait-time study called into question

by Leo Almazora30 Nov 2016
"The Fraser Institute methodology is — and I use the word carefully — an abomination," said Saskatoon-based health policy consultant Steven Lewis in a Globe and Mail report, which highlighted concerns surrounding the institute’s latest study of Canadian healthcare waiting times.

The institute’s report cast an unfavorable light on the Canadian public health system, finding that Canadian patients could wait up to 38.8 weeks to be accommodated for a specialized procedure. The study was conducted by sending a survey to thousands of doctors all over the country, enticing them with a chance to win $2,000; despite the offer, only about 1 in 5 doctors participated.

Furthermore, rather than asking the specialists to check patient records or submit data, the six-question survey just asked them to estimate how long their patients wait to see them, then wait for tests or surgeries to be conducted. “Why not use a thermometer rather than asking people for their opinion about the weather?” said Lewis.

Fraser Institute senior economist and report author Bacchus Barua said that researchers would like more responses, but it’s not within their control. Nevertheless, health policy experts agree that the methodology is vulnerable to flaws such as participation bias, which is a systemic bias towards those who choose to respond, and individual biases due to potential subjectivity in mentally averaging wait times.

Barua said that his only agenda in doing the study is “to inform patients about wait times in Canada,” but the 2013 issue of the report has been used as evidence in an ongoing constitutional challenge against Medicare in BC. According to Simon Fraser University adjunct professor and health policy analyst Karen Palmer, flaws in the Fraser Institute reports were exposed when one of the researchers, testifying as an expert witness, was cross-examined by lawyers representing BC and Canada.

“I think it's unfortunate that it goes out unchallenged every year,” said Palmer, noting that media coverage of the study undermines confidence in the public health system.

Lewis said that it should be easy to calculate wait times based on actual patient and hospital records. However, Barua said that the Fraser Institute lacks the resources to do a more detailed study, and sticking to their old format allows researchers to compare results from one period to the next.

Another report on patient waiting times was released by the Canadian Institute for Health Information in March. Its overall conclusion: "Wait times for urgent procedures were at or approaching benchmark targets."

As for reported instances of long waiting times among patients, Palmer believes they were cases of miscommunication. “There's sometimes a disconnect between the patient's perceived need and the physician's professional judgment of the urgency,” she said. “For those who are legitimately waiting too long, we need to improve how we organize and deliver care.”

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