Timely Access to Care : Exploring the Gender Dimensions

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Wait times in medicine and health care have been the subject of long debate in Canada. How long someone must wait to see a doctor, to get an appointment, to be seen once at the doctor’s office, how long to receive a diagnostic test and the result, how long to be admitted to hospital, how long to get a bed on a ward (as opposed to waiting in a hallway), and how long to be cured. These are recurrent topics of debate and media coverage.

Personal stories in particular are compelling and we are all touched when we hear that the health system has not met a patient’s needs, and we feel relieved when the news is better and our friend or relative has been treated well by the Canadian health care system we treasure.

But as this list above illustrates, the notion of “wait times” is broad. It is a flexible term that can relate to any of the “times” between wanting to see a physician, to treatment and cure. It is also not always clear in media or personal reports who is waiting and what she or he is waiting for.

For over 10 years, Women and Health Care Reform (WHCR) has examined how health care and health care reforms affect women in Canada. WHCR uses gender-based analysis in research, policy advice and communications to examine why health reform issues are women’s issues, and what the issues are for women. As part of this work, WHCR hosted a workshop with provincial and federal health planners and policy makers in March of 2007 to invite an open discussion about how gender-based analysis can be used to better understand the concepts of wait times and how they affect women.

The meeting arose from an invitation to contribute to an appendix to the Federal Advisory Report on Wait Times released in 2006. In the appendix, Women and Health Care Reform authors demonstrate how gender-based analysis gives a much broader understanding of “wait times” for one kind of procedure: total joint arthroplasty (TJA) (hip and knee replacement surgeries). The authors of the paper describe a journey to surgery that, upon closer examination, starts long before the wait to be on a surgical list.

Through gender-based analysis (GBA) the authors describe who is more likely to suffer the conditions that most often lead to needing TJA (women) and who is more likely to be recommended for surgery (men), who is more likely to turn down a surgery date (women) and why (because they are already taking care of someone else, they cannot take time from work, or they will not have anyone at home to help during recovery). The authors found that a GBA inquiry answers typically unasked questions, and opens the way for new questions.

In applying GBA to “wait times” in this case study, WHCR recommended that a more appropriate representation of the issue, rather than “wait times,” would be “timely access to care,” and this became the title for the March 2007 workshop, co-hosted by WHCR and the Women’s Health Contribution Program members.*

The intent of the workshop was two-fold. First, it was designed to expand policy debate and analysis on the evolving issue of wait times, broadening the discussion to one of “timely access to care,” taking into account determinants of health and population health approaches.

Secondly, through the use of concrete examples, the workshop illustrated how consideration of the unique needs and circumstances of diverse groups among women and men, with particular attention to marginalized groups, adds value to policy, research and program development on wait times and to the broader issue of timely access to care. GBA thus strengthens health planning and service delivery for governments at all levels.

Approximately 60 distinguished policy researchers and analysts from Health Canada and the Public Health Agency of Canada, provincial and regional sectors, were invited to attend the meeting. Together and in small working groups, the participants explored ideas, challenged assumptions, raised questions about the notions and paradigms of timely access to care in Canada and investigated the additional dimensions that GBA bring.

The workshop opened with a panel discussion between noted writer and physician Dr. Michael Rachlis and Dr. Pat Armstrong, Professor of Sociology at York University and the Chair of WHCR. In his opening presentation, Rachlis pointed out that wait times are not cured and that simplified models developed to increase physician and nurse expediency alone cannot rectify patient backlogs. Armstrong supplemented these important points in her opening discussion noting that we must know more about who the patients are, where they’ve come from, what supports they have at home, and who is caring for them, including their own context.

With these introductory words as the backdrop, WHCR invited participants to join one of four hands-on sessions, exploring GBA and timely access to care in the areas of programs for Aboriginal populations, hip and knee surgeries, health care work place and mental health. Session facilitators used case studies and exercises to give participants practical experience in applying GBA to surveillance data, program design and health conditions.

The workshop sessions demonstrated the direct relevance of GBA to research, policy and program development in health contexts, while the morning session keynote speakers and discussion panel highlighted key concepts, applications and research findings, illuminating the ways in which GBA is contributing to performance improvement and health outcomes for both men and women.  

At the end of these sessions, five respondents were invited to reflect on the knowledge they had gained over the course of the day, and to comment on the applicability of GBA to their own projects. Each respondent brought a unique perspective to the panel and, further emphasizing the relevance of integrating GBA to inform issues of timely access, highlighted clear objectives for the implementation of this analytical tool.

All panelists acknowledged that the ways in which GBA challenges assumptions of equal treatment, and allows space for the discussion of inclusion and context, were especially relevant to their own settings and project s. Many of those on the reflections panel agreed that, as a result of the lessons learned throughout the day, they would approach issues pertaining to timely access in more gender-sensitive ways, and that they would encourage others to do the same.

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*The Women’s Health Contribution Program members include the Aboriginal Women’s Health and Healing Research Group, the Atlantic Centre of Excellence for Women’s Health, the BC Centre of Excellence for Women’s Health, the Canadian Women’s Health Network, the National Network on Environments and Women’s Health, the Prairie Women’s Health Centre of Excellence, Women and Health Care Reform and Women and Health Protection.