TORONTO, ON—Canada’s health insurance system, the sixth most expensive among OECD countries, trails its international counterparts in terms of providing Canadians with medical resources and services, concludes a new report from the Fraser Institute, Canada’s leading public policy think-tank.
"Despite having one of the highest levels of health spending worldwide, Canada’s health insurance system is not providing Canadians with the same levels of access to medical resources and services as most other comparable countries," said Mark Rovere, Fraser Institute associate director of health policy studies and study co-author.
Value for Money from Health Insurance Systems in Canada and the OECD: 2012 Edition uses comparable data from 2009, the most recent year available, to compare the amount 28 OECD (Organization for Economic Co-operation and Development) countries, including Canada, spend on health care against the availability of medical goods and services represented by 20 indicators of medical resource availability and output of medical services. Population health outcomes are not used in the analysis.
"The output of medical treatment is human health but in order to determine if a country is getting value for the money it spends on health insurance, you need to measure how readily patients can obtain medical goods and services," Rovere said.
The study found that in 2009 Canada had the sixth highest rate of health insurance expenditures at 11.4 per cent of GDP, only behind the United States (17.4 per cent), the Netherlands (12.0 per cent), France (11.8 per cent), Germany (11.6 per cent), and Denmark (11.5 per cent).
While Canada’s health insurance system was among the most expensive, it ranked below the majority of OECD countries on 15 out of 20 indicators representing the availability of medical resources and services. Canada ranked particularly low on the number of practising physicians per population (19th out of 23 countries), the number of acute care beds per population (tied for last out of 26 countries), the number of percutaneous coronary interventions per population (26th out of 27 countries), and the number of hip replacements performed per population (21st out of 28 countries).
The report highlights the fact that Canada is the only OECD country where private comprehensive medical insurance is effectively prohibited, and one of only four OECD countries that do not require some form of patient cost-sharing for medically necessary care.
The study also shows that countries which produce better value for money from health insurance had some or all of the following policies in common:
- Patient cost-sharing required for publicly funded medical goods and services;
- Medical goods and services financed through some form of public-private social insurance (usually pluralistic), where individuals and employers make direct and significant contributions to premium costs;
- Comprehensive private health insurance options; and
- Private for-profit hospitals permitted to bill public health insurers for services.
"Canada’s government-run health insurance system is defined by rationing of health services, unnecessary waits for treatment, and poor availability of new medical technologies. Canadian taxpayers are not getting good value for money from their health insurance," Rovere said.
"Governments should consider reforms such as patient cost-sharing, competition, and private insurance options. Other developed countries produce better value for money from these sensible policies and Canada should follow suit."