What kind of health care system do we get for our tax dollars?

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Appeared in the Alaska Highway News and Fredericton Daily Gleaner

As the calendar flips to May, and the income tax deadline safely passed for another year, Canadians can at least take solace in all the wonderful things that government does with our tax dollars, like Canada’s much-vaunted universal health care, right?

Given that more than one half of the personal income taxes Canadians pay in aggregate are required to cover the cost of taxpayer-funded health care programs, surely we are getting value for all that money. Unfortunately, comparisons to other industrialized countries with universal health care systems clearly show that Canadian taxpayers aren’t getting their money’s worth when it comes to health care.

Canadians are funding the developed world’s third most expensive universal access health insurance system. Yes, you read that correctly. On an age-adjusted basis (older people require more care) in the most recent year for which comparable data are available, only Iceland and Switzerland spent more on their universal access health insurance systems than Canada as a share of GDP. The other 25 developed nations who maintain universal health insurance programs spent less than we did; as much as 38 per cent less as a percentage of GDP in the case of Japan.

With that level of expenditure, you might expect that Canadians receive world-class access to health care. The evidence finds this is not so.

Consider the case of waiting lists. In 2007, waiting lists for access to health care in Canada reached a new all-time high of 18.3 weeks from general practitioner referral to treatment by a specialist. Despite substantial increases in both health spending and federal cash transfers to the provinces for health care over the last decade or so, that wait time was 54 per cent longer than the overall median wait time of 11.9 weeks back in 1997.

Canada’s waiting lists are also among the longest in the developed world. For example, a 2007 survey of individuals in seven nations, six of whom maintain universal access health insurance programs, published in the journal Health Affairs found that:

• Canadians were more likely to experience waiting times of more than six months for elective surgery than Australians, Germans, the Dutch, and New Zealanders but slightly less likely than patients in the United Kingdom; and were least likely among the six nations to wait less than one month for elective surgery;

• Canadians were most likely to wait six days or longer to see a doctor when ill, and were least likely to receive an appointment the same day or next day among the six universal access nations surveyed;

• Canadians were least likely to wait less than one hour and most likely to wait two hours or more for access to an emergency room among the six universal access nations surveyed.

That is hardly the sort of access you might expect from the developed world’s third most expensive universal access health insurance system. Seven other developed nations, Austria, Belgium, France, Germany, Japan, Luxembourg, and Switzerland, maintain universal access health insurance programs that deliver access to health care without queues for treatment.

Access to medical technologies is also relatively poor in Canada. In a recent comparison of age-adjusted inventories of medical technologies, Canada ranked 13th of 24 nations for whom data was available in MRI machines per million population, 18th of 24 nations in CT scanners per million population, 7th of 17 in mammographs per million population, and tied for 2nd last among 20 nations in lithotripters per million population. Canada’s relatively high spending on health care is not resulting in quick access to care, nor is it leading to high tech health care services.

Governmental restrictions on medical training, along with a number of other policies affecting the practices of medical practitioners, have also taken their toll on Canadians’ access to care. Among 28 developed nations who maintain universal approaches to health insurance, a recent comparison found Canada ranked 24th in the age-adjusted number of physicians per thousand population. It should come as no surprise that Statistics Canada determined in 2003 that more than 1.2 million Canadians could not find a regular physician, while a recent estimate of the number of Canadians without a regular physician put the number somewhere around 5 million.

When all is said and done, the evidence makes it clear that Canadians are paying for a world-class health care system but are not receiving one. Shouldn’t we expect more from our tax dollars?

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