Canada should learn from countries that do universal health care differently—and better

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Appeared in the National Post, September 28, 2017

As patients, caregivers and taxpayers, all Canadians care deeply about our health-care system. It’s important to us that the system has the necessary medical resources, is accessible, and delivers high-quality treatment at an affordable and sustainable cost.

Unfortunately, it’s increasingly clear that we have a high-cost system that delivers mediocre, and sometimes remarkably poor, performance—especially compared to other countries that share the same goal of universal access, regardless of ability to pay.

Gone are the days when such underperformance could be swept under the rug and the American health-care system could be dangled as the only alternative—the boogeyman scaring us into believing that the status-quo was necessary to preserve the universal nature of Canadian health care. Rather, we are now far more aware that Canada’s is but one way of doing universal health care. And the consequences of our policy choices are increasingly obvious.

The Fraser Institute’s annual checkup released this week compares Canada’s health-care spending and performance to 28 other universal health-care systems on an age-adjusted basis. We rank amongst the highest spenders—3rd in fact, as a percentage of our economy, and 11th on a per person basis.

However, we have remarkably few medical resources to show for that spending. We rank near the bottom of the pack for the number of physicians available (25th out of 29), and dead-last for acute-care beds. It’s no wonder we hear so many stories about families in need of physicians, long wait times for treatment, and overcrowded hospitals.

In fact, Canadians have come a long way towards understanding the deteriorating state of wait times in our country. For example, while some may quibble over methodological differences, most accept the overall conclusion of the Fraser Institute’s annual survey—that patients in Canada are waiting longer than ever, and that physicians consider such wait times longer than medically reasonable.

Data from other organizations such as the Commonwealth Fund defuse the notion that such wait times are a natural consequence of universal health care. For example, 30 per cent of Canadian patients reported waiting for two months or longer for an appointment with a specialist, compared with only 3 per cent in Germany, 4 per cent in France and 7 per cent in the Netherlands. Similarly, 18 per cent of patients in Canada reported waiting four months or longer for elective surgery compared to no patients—zero—in top-performing Germany.

To be fair, there are some areas where we do reasonably well. For example, our system delivers more consultations with family doctors, cataract surgeries and knee replacements than the average universal health-care system. We also have fewer patients dying after a heart attack, and a stellar record on breast and colorectal cancer survival.

On the flip side, higher than usual mortality after ischemic strokes, average survival rates for cervical cancer, and the worst record for obstetric trauma (injury to the mother while giving birth). Canada also reports the lowest amount of hospital activity (as measured by discharge rates). On this measure, an optimistic view would be that our system is good at keeping patients healthy and out of the hospital. However, a more sober analysis suggests the existence of a bottle-neck of patients waiting to be admitted—a view evidenced by the hundreds of thousands of Canadians waiting for treatment. And of course, there remains the question of why our system costs so much if it delivers fewer expensive in-hospital treatments to patients.

While the tireless defenders of the status-quo will undoubtedly continue to selectively focus on the few bright spots, the wealth of evidence suggests we have a lot of work to do. Crucially, simply pumping more money into an already expensive system is clearly not the answer.

Let’s take this opportunity to eat some humble pie, identify countries that do better than us on any of the 42 performance metrics identified in the Fraser Institute’s report, and learn about what they do differently so we can improve our system for patients who need it most.

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