Income has no role in children’s surgery

Sick Kids study finds no bias for richer families

A new Canadian study suggests that children from less affluent families don’t have to wait longer for needed surgeries than kids who are well off.

Researchers from Toronto’s Hospital for Sick Children conducted the study, which looked at nearly 40,000 surgeries done at the hospital between 2005 and 2011.

Senior author Dr. James Wright says the goal was to see whether socio-economic status affects how fast children make it through the system when they need operations.

Wright says the researchers did not know going into the study whether family income played a role in surgical wait times among pediatric patients in a publicly funded health-care system such as Canada’s. Children’s postal codes were mapped against census data, which can be used to estimate what people earn depending on where they live.

The study is being published in the journal Pediatrics.

Even though one would expect a publicly funded system to be less influenced by a patient’s wealth than one that requires citizens to purchase their own health-care coverage or acquire it through their employment, Wright says socio-economic status can still be a barrier to care.

The researchers looked at two wait periods — the time between when children were referred to a surgeon by their family physician or pediatrician, and the time from the decision to proceed with surgery to the operation itself.

In neither case did children from lower income households wait longer than more affluent kids.

“As the surgeon in chief at the Hospital for Sick Children, as a practising orthopedic surgeon, as a member of society, I’m very pleased to see that for this segment of the population … which we tend to value and place priority on, that we’re able to stand up proudly and say at least in our hospital that socio-economic status doesn’t appear to be a barrier to care,” Wright says. “That’s a good finding. It’s good for families and it’s good for the system.”

The Hospital for Sick Children cares for the sickest of the sick among Ontario children, and even draws patients from beyond the province’s — and Canada’s — borders. As such, Wright acknowledges that its performance may not be typical of what would be experienced by children waiting for less pressing operations at a community hospital. Still, he notes that children’s surgeries often have an urgency to them, a need to correct something before a developmental window closes and lifelong consequences ensue. Adults sometimes have surgeries for non-urgent reasons — to fix a deviated septum to ease breathing or reduce snoring, for instance. But children rarely go under the knife unless there is a compelling and often time-sensitive reason.

“It’s much more: ‘Gee, if we don’t do this someone won’t be able to see for their whole life. Someone won’t be able to hear well. Someone’s language, if they don’t have an implant in their ear, their language will never develop’,” Wright explains.

Health system analyst Steven Lewis says while the study’s findings may not reflect circumstances children face at general and community hospitals, he wouldn’t be surprised if they too treat kids like this. “I think there may be an underlying enhanced commitment to equity for kids,” says Lewis, based in Saskatoon.

That doesn’t mean to say that children always get treated as quickly as experts advise. The study found a third of patients waited longer than pediatric experts recommend for their surgical consultation — the first wait time measured — and 28 per cent waited longer than recommended for the consultation-to-operation period.