Medicare by Numbers

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Appeared in the Ottawa Citizen, 21 April 2005

On Monday, Canada’s Health Minister Ujjal Dosanjh made the remarkable claim that “Canada’s health system compares favourably to other OECD (the Organisation for Economic Cooperation and Development) countries in terms of access and health outcomes.” A look at the readily available data on Medicare’s comparative performance suggests that Mr. Dosanjh is sorely misinformed. In reality, Canadians have little to be proud of with regard to their very expensive Medicare program.

Data on the availability of medical technologies suggest that Canadians are actually receiving dismal access to care when compared to their counterparts in other developed nations that guarantee access to care regardless of ability to pay. In an age adjusted comparison of machines per million population, Canada ranks 15th of 24 countries for whom data is available for access to MRI machines, 17th of 23 for access to CT scanners, 8th of 22 for access to radiation therapy machines, and last of 15 nations for access to lithotriptors (machines used to break up stones in the body). Clearly, Canada does not compare favourably to other universal access OECD nations in comparisons of access to high tech medicine.

A similar story emerges in comparisons of access to physicians. In an age adjusted comparison of physicians per 1,000 population, Canada ranks 16th of 23 nations for whom data is available. Looked at another way, 15 developed nations who also guarantee access to care regardless of ability to pay provide superior access to physicians for their populations. That is not a ‘favourable’ comparison for Canada.

Finally, Canada does not compare all that favourably in terms of health outcome measures which are readily available from sources such as the OECD, the World Health Organization, and the British Medical Journal. Canada’s health care program ranks seventh in medically avoidable mortality, ninth in potential years of life lost to disease, and sixth in the incidence of breast cancer mortality. Only in one comparison of health outcomes does Canada manage a top ranking performance: the incidence of mortality from colorectal cancer.

Information from scholarly journals suggests Canadians are also waiting much longer than patients elsewhere in the developed world for elective treatments, partly a result of a paucity of physicians and medical technologies. At the same time, information from the OECD suggests that patients in 7 nations (Austria, Belgium, France, Germany, Japan, Luxembourg, and Switzerland) endure virtually no waits for medically necessary treatment.

The evidence on Medicare’s relative performance compared to other developed nations with health programs sharing our goal of access to care regardless of ability to pay is clear: the Canadian health care program provides poor access to mediocre health services. How anyone could call that comparative performance ‘favourable’ boggles the mind.

Finally, this poor performance is not, as many will be quick to suggest, the result of a lack of spending. In fact, no developed nation spends more than Canada to guarantee access to care regardless of ability to pay for all their citizens.

Those nations with superior health care performances, such as Sweden, manage to do so through superior health policies that both encourage the production of high quality health services and more informed decision making on the part of patients. Such policies include cost sharing for medically necessary services and a private parallel health care sector, both of which are forbidden by the Canada Health Act, and the private provision of publicly funded services. Consider that Sweden ranks 15th in health spending, outperforms Canada in access to physicians and medical technologies like CT and MRI, and outperforms Canada in outcomes from care. Other nations that also outperform Canada on health outcomes (Australia, Japan, and France) manage their superior performances by employing those same health policies.

Canadians should be wary of any claim that the Canadian health care system outperforms or even performs on par with its European or Asian counterparts. The comparative evidence is quite clear: Canada’s health care program provides dismal access to mediocre health services at very high cost. And those programs that outperform Canada’s do so through the very policies that are either forbidden by the Canada Health Act or have been actively discouraged by those who are in charge of enforcing its myriad rules and regulations. Such a ban on good policy is ultimately harming the very patients it is supposed to be protecting.

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