Another reminder that Canada does universal health care the wrong way
Last week, we received another reminder of the chronic underperformance of the Canadian health-care system, this time from the Canadian Institute for Health Information and the Commonwealth Fund.
The International Health Policy Survey of Primary Care Physicians interviewed more than 2,000 physicians in Canada, and compared them with responses from physicians in Australia, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States.
Canada performed below average on five (out of six) indicators measuring access to care, below average on four (out of four) indicators measuring the adoption of information technology, and below average on four (out of five) indicators of measuring the degree of performance measurement. Canada’s performance on indicators measuring the co-ordination of care within the system was neither here nor there (better on six, worse on six, and average on one).
While there is much to be gleaned from the report, let’s focus on that area of concern that we most spectacularly fail at: timely access to care.
The survey found 70 per cent of Canadian primary care doctors thought their patients often experienced long wait times to see a specialist—the worst showing of any country surveyed.
On a somewhat better note, about 21 per cent of Canadian physicians surveyed thought their patients often experienced long waiting times to receive treatment after diagnosis—about average amongst the countries in the report. Unfortunately, 40 per cent of Canadian doctors also reported that patients often experienced difficulty getting specialized diagnostic tests in the first place! Only New Zealand fared worse.
Such results should come as no surprise to those already familiar with the sorry state of delays in accessing health care in Canada. Indeed, the most recent edition of the Fraser Institute’s wait times report (Canada’s only national, comparable and comprehensive measurement of wait times) found that Canadian patients could expect to wait 8.5 weeks to see a specialist after referral from a family doctor, after which they faced another 9.8 week wait for treatment.
What is extremely interesting, however, is a quick analysis of the health-care policies of the countries that perform better than Canada on the Commonwealth Fund Survey indicators discussed above. Each ensures universal access to health-care services (except, perhaps the United States). However, every country that performs better than Canada on the indicator measuring wait times to see a specialist allows the private sector to operate either alongside the public system, or includes them as a partner. Most of them (except the United Kingdom) also expect patients to pay user-fees and share in the cost of treatment (to a limit).
Countries that perform worse than average for access to treatment after diagnosis, (New Zealand, the U.K., Sweden, Australia and Canada) all operate large tax-funded health-care systems. On the other hand, almost every country that does better (Germany, the Netherlands, the United States and Switzerland) relies on competitive insurance markets and allows for a much greater role for the private sector.
Of course, we cannot draw any definitive conclusions based on these results and a superficial glance at the health-care policies employed in countries that perform better than Canada. Still, it’s hard to ignore the fact that when it comes to timely access to care, universal health-care systems that allow private insurance and delivery of medical services, and employ user-fees, routinely do much better than Canada.