Determinants of unacceptable waiting times for specialized services in Canada.

BACKGROUND Much of the current evidence regarding timely access to healthcare services focuses on the duration of the waiting time as the principal determinant of wait time acceptability. We conducted the first national-level analysis of wait time acceptability in Canada to identify the determinants of unacceptable waits for specialized healthcare services, including selected demographic and socio-economic variables. METHODS We analyzed data reported by respondents to a national survey on access to healthcare services who accessed specialized services (i.e., specialist visits, non-emergency surgery and selected diagnostic tests) during a 12-month period. We used univariate analyses and weighted logistic regression to examine the relation between wait time acceptability and selected demographic, socio-economic and health status factors for each specialized service. RESULTS Between 17% and 29% of patients who waited for a specialized service declared that their waiting time was unacceptable. Most individuals reported waiting less than 3 months for their services. Between 10% and 19% of those who waited indicated that waiting for care affected their lives. Results of the logistic regression analyses showed that longer waits and adverse experiences during the waiting period were significantly associated with higher odds of reporting an unacceptable waiting time for all three types of specialized services. The role of socio-economic and demographic factors on wait time acceptability was varied. Individuals with lower education were consistently less likely to consider their waiting times unacceptable. Patients less than 65 years of age were more likely to consider their waiting times unacceptable for specialist visits and diagnostic tests. INTERPRETATION Our study shows that the primary determinants of waiting time acceptability are the length of the waiting time and the effects of waiting on the patient's life. In addition, some patient characteristics, such as age and education, may play a role, pointing to the potential role of patient expectations in determining the acceptability of waits for specialized services.