Week 3: Wait times and Identifying Policy Problems and Getting Them on the Agenda

Question 1

What causes wait times?

Answer 1

-If the demand for care outdoes the supply we have
-If we don’t have enough specialists or nursing/ support staff required to provide adequate hair
-Disorganization inefficiency
-Going to the hospital for care that you could’ve went to your doctor for

Question 2

Wait times

Answer 2

the demand for treatment exceeds the supply, either due to lack of capacity or inefficient use of existing capacity

Question 3

What was the example used in lecture of the wait time at university hospital to see physician

Answer 3

12.25 hrss

Question 4

What two wait times does Ontario health tracks

Answer 4

Time from referral to first clinician appointment (wait 1)
Time from decision to surgery (wait 2)

Question 5

What is the main problem of wait times

Answer 5

people are dying
-In ER
-Cancer patients dying before first consultations

Question 6

True or False: Canadians were less likely to receive care within 4 hours at the emergency department compared with other commonwealth countries

Answer 6

True

Question 7

True or False: respondents in urban communities were more likely to wait than rural communities

Answer 7

false rural more likely to wait

Question 7

True or False: More canadians waited longer for specialist appointments and elective surgeries compared with CMWF average

Answer 7

True

Question 7

What % of respondents who wanted help for mental health received treatment

Answer 7

43%

Question 7

True or False: things got worse during the pandemic

Answer 7

true

Question 7

what fraction of Canadians reported they had wanted to talk to a doctor or other health professional about their mental health in the past year

Answer 7

1/5

Question 8

What percent of canadians want to focus on fixing wait times?

Answer 8

43%

Question 8

Are total waitlists and time placements going up or down

Answer 8

up

Question 9

True or False: people in health care perceive wait times as one of the most important care issues

Answer 9

true

Question 10

As of September 2002 aprrox how many ontarians on wait lists for surgical procedures

Answer 10

250, 000

Question 11

Of the 250,000 patietns how many # and percent were waiting longer than the maximum clinical guidelines for their surgery (called long waiters)

Answer 11

107, 000, 43%

Question 12

True or False:
Growth in elderly ontarians has exceeded growth in the number of hospital beds
Growth in elderly ontarians has exceeded growth in the number of long-term care beds

Answer 12

True

Question 13

What is ontarios wait time strategy and what year did it come out

Answer 13

2004,
Provides funding to hospitals to provide additional wait list surgeries, MRIs, and CTs
As a condition of funding, hospitals must supply and verify their wait times information to the ‘wait times information system’

Question 14

What does having mandatory reporting wait times do

Answer 14

Measures the problem
Tracks the problem over time
Enhances accountability for addressing the problem
Redirects patients to shorter wait lists via patient choice

Question 15

Benchmarks

Answer 15

targets representing the maximum amount of time a patient should wait, beyond which evidence shows adverse health effects will likely occur

Question 16

What percent of breast cancer patients are seen within a target time

Answer 16

86%

Question 17

Provincially ___ patients get the surgery within time to not experiencing adverse health outcomes,__ are not getting treated in time to avoid adverse health outcomes

Answer 17

81%, 1/5

Question 18

What fraction of patients get scanned within target time

Answer 18

1/3

Question 19

What fraction are expected to experience adverse health outcomes cause they waited to get an mri

Answer 19

2/3

Question 20

What percent are experiencing mri within target time

Answer 20

15%

Question 21

True or False: “Government mandated legislation for the creation of benchmark targets, mandatory tracking, and reporting of wait times in psychiatry do not currently exist in Ontario”

Answer 21

true

Question 22

Alternative Policy solutions (I PEAR EI)

Answer 22

Increase after-hours care

Pay-for-performance

Eliminate inappropriate tests and treatments

Activity-based funding

Recruit/increase pay for key human resources

Establish centralized intake of patients

Integrate funding models

Question 23

What is the plan as of 2027 for the cohort of med students

Answer 23

if you want to be a family doctor, extending residency from 2 years to 3 years.

Question 24

Your health act

Answer 24

Explain in own words (summarize) and what are the problems

Question 25

Agenda setting example

Answer 25

Explain in own words summarize

Question 26

How many confirmed lab cases of e coli outbreak

Answer 26

348, almost all under the age of 5

Question 27

How many were hospitalized of the outbreaks and how many were put on dialysis

Answer 27

20 hospitalized, 12 on dialysis

Question 28

How many are currently still in hospital

Answer 28

6

Question 29

Affected how many people each?

Answer 29

2000

Question 30

How many daycares were shut down

Answer 30

7

Question 31

What are the agenda and doctors examples of ?

Answer 31

Policy makers caring about certain issues because of a crisis

Question 32

Focusing events are..

Answer 32

-sudden
-relatively uncommon
-can be reasonably defined as ‘harmful’ or revealing the possibility of potentially greater future harms
-have harms that are concentrated in a particular geographical area or community of interest
-known to policy makers and the public simultaneously (often what gets things on the policy agenda)
-may create policy windows

Question 33

Policy windows

Answer 33

“points in time when the opportunity arises for an issue to come into the policy agenda and be taken seriously with a view to action”

Question 34

True or false Public health agency of canada (federal), public health ontario (provincial) , didn’t exist before sars outbreak

Answer 34

true

Question 35

True or false: focus events are a sure way to get something on the agenda

Answer 35

False… are not… sandy hook example
ex. Sandy Hook shooting. Many people thought that tragedy was so unmatched that change could’ve been made around gun policy. Weren’t successful, massive tragedy, and didn’t affect the change people thought it would. People thought if that didn’t do it then nothing could change gun policy in the United states.
Not necessarily for sure but can sometimes lead to change

Question 36

Policy agenda

Answer 36

List of issues to which an organization, usually the government, is giving serious attention at any one time with a view to taking some sort of action.”
-things they acc put on the agenda

Question 37

Agenda setting

Answer 37

Process by which certain issues come onto the policy agenda from the much larger number of issues potentially worthy of attention by policy makers.

Question 38

True or False: policy change begins with agenda setting, policy change cannot happen without it being on the agenda of policy makers

Answer 38

true

Question 39

True or false: we create crisis to get policy attention

Answer 39

fasle

Question 40

How to get issues on the policy agenda

Answer 40

-Focusing events
-incrementalism/politics as usual
-burden of disease

Question 41

incrementalism

Answer 41

policy change occurs, if it does at all, through a gradual accumulation of small changes

Question 42

Rational model of policy-making

Answer 42

1. identify the problem
2. establish decision criteria
3. weigh decision criteria
4. generate alternatives
5. evaluate the alternatives
6. choose the best alternative
7. implement the decision
8. evaluate the decision

Question 43

True or False: If we can point to more deaths or morbidity from a certain issue we can get people to care more of it

Answer 43

true (example covid)

Question 44

Top 5 reasons for hospital stays

Answer 44

1. giving birth
2. covid
3. heart failure
4. heart attack
5. substance use disorders

Question 45

True or False: Currently experiencing first peak wave of covid patients since first lock down

Answer 45

True

Question 46

Influenza flu deaths in canada 2019-2020
# influenza flu deaths in canada, 2020-21# and why?
influenza flu deaths in canada 2021-2022
# Covid 19 deaths in canada, 2020-present

Answer 46

1. 120
2. 0 (due to covid)
   3.22
3. 53, 644 and will continue to see more

Question 47

True or False:

Answer 47

Higher burden of disease, more policy makers will care and do something about it but thats not usually the CASE

Question 48

True or false: How one defines/ frames a problem will impact whether it gets on the policy agenda,
How one defines/frames a problem , predicts policy solutions

Answer 48

true

Question 49

Law of instrument

Answer 49

if you have a hammer, everything looks like a nail

Question 50

Agenda setting models

Answer 50

Empirically-based models that help to explain why particular issues get on organizations/ governments policy agendas, or why they do not reach policy agendas

Question 51

Hall et als model of legitimacy, feasibility and support

Answer 51

…Only when an issue and likely response are high in terms of their legitimacy, feasibility and support do they get on to a government agenda

Question 52

Legitimacy

Answer 52

“a characteristic of those issues which policy makers see as appropriate for the government to act on” (ex. My body my choice)
Mayor of new york did not get law banning big soda from corner store passed, seen as illegitimate, that’s not what government is for, etc
Anti-trans rallies met with counter-protests across ontario

Question 53

Feasibility

Answer 53

“a characteristic of those issues for which there is a practical solution.”
Relevant even to institutions like western or hospitals, not just government
When cannabis was legalized, discussions about how it will be delivered in a legal way (lcbo style, government run cannabis model), or private entities ability to open dispensaries, getting licenses etc.
What possible, what is the government capable of doing?
Practicality has a huge impact there as well.

Question 54

Support

Answer 54

a characteristic of those issues to which the public and other key political interests want to see a response.”
Extent to which people care about it might not be enough to get it on the policy agenda.

Question 55

Kingdoms policy streams/multiple streams model (3 Ps 3 streams)

Answer 55

Policies are only taken seriously by governments when:

The problem they are addressing is perceived as being a public matter requiring government action

The policy solutions being proposed are perceived as technically feasible and consistent with dominant social values

The politicians/ policy makers have the motivation and opportunity to enact policy solutions
Kingdon says instead of rational model what we have is more of a “trash can model”

-All operating independently from each other and policy makers come together and create a policy window to see those 3 things happen.

• Problem stream: “indicators of the scale and significance of an issue which give it visibility”
  Is there a problem? What is it?
  Do we know/ is there consensus regarding the cause(s) of the problem?
  Do people know about the problem? (public perceptions of the problem)
  ‘Problem recognition & framing’

-Policy Stream
“The set of possible policy solutions or alternatives developed by experts, politicians, bureaucrats and interest groups, together with the activities of those interested in these options.”
Are there practical, possible policy solutions to address the problem? If there isn’t,, this isn’t going anywhere

-Politics stream
Political events such as shifts in the national mood or public opinion, elections and changes in government, social uprising, demonstrations and campaigns by interest groups.”
Is there political will to address the problem?

Question 56

Explain opiod crisis example

Answer 56

opioid crisis
# of ppl affected by opioids getting worse, is there a problem , is there a consensus about it, is there visibility, YES

Opioid crisis: policy stream, can’t eradicate it but, yes there are some things we can do about it, good evidence that there are some good solutions (like safe injection sites could help a little bit)

Opioid crisis: politics stream, cut some injection sites because area residents were upset, policy makers need to be in power if they wanna make change, need to do some things to appease public of voters, illustrative of how that can manifest at the political level, other interests may prevent from taking action on those issues

Question 57

Who are assed contributions

Answer 57

member states of the UN

Question 58

CVCA

Answer 58

core voluntary contributions account, help fund WHO, goes to core programs already existing in WHO

Question 59

Voluntary contributions

Answer 59

specified, country or other organization willing to give to WHO contingent on spending it a certain way.

Question 60

True or False Significant amount of the WHO budget is those specified voluntary donations, dependent on countries or organizations giving money and telling them how to spend it. If they don’t want to do it then they won’t get that funding.

Answer 60

True

Question 61

Bill and Melinda Gates Foundations

Answer 61

second biggest (2016-2017) funders of the WHO, but all the money they donate has to be spent how the Gates foundation tells them to spend it.

Question 62

True or False:

Answer 62

The power to keep things off the policy agenda is as important as understanding the power to push certain issues on the governments agenda