Canada’s health minister is right about one thing—there’s lots of work to do
“Moving up the rank, one step at a time #muchmoretodo.” Those are the words Dr. Jane Philpott, Canada’s health minister (pictured above), tweeted upon the recent release of the Commonwealth Fund’s international ranking of health-care systems. To be clear, Canada moved up a notch from ranking a dismal 10th out of 11 in 2014, to an equally dismal 9th out of 11 this year. Anyone who considers this even close to laudable progress should set a much higher bar for success.
Importantly, a closer examination of the report reveals that Canada’s better overall ranking is partly a result of France simply faring worse this year than it usually does in most areas measured by the report. In fact, Canada only improved in the fuzzy domains of Care Process (which includes “soft” indicators about how often patients talk to their doctors about exercise and stress) and Administrative Efficiency. By contrast, Canada actually slipped down a rank in terms of Access and Health Outcomes—two areas that Canadians are likely far more concerned about.
While I have some serious concerns about any report which ranks the United Kingdom as the best health-care system overall (when it also ranks it as the second worst in terms of health-care outcomes), there are some important takeaways worth discussing.
The most obvious is the simple fact that Canada does not have the best health-care system in the world. Besides the Commonwealth Fund’s most recent ranking, the WHO ranked it number 30 (out of 191) way back in 2000, and the Fraser Institute’s annual reports consistently show that we still do not receive good value for our money.
The second, is that we need to get away from our health-care policy discussions routinely devolving into nationalistic chest-pounding exercises of pointing out our superiority to the United States, which ranked 11 (out of 11) in the Commonwealth Fund’s survey. While the American system is perhaps one of the most innovative in the world, and provides emergency care to vulnerable populations in a number of alternative settings, it clearly is a very expensive system and struggles in many important areas. The fact that we do better than the U.S. on a variety of measures is meaningless because we should compare ourselves to countries that do better than us, not worse, on the metrics we’re interested in.
And this brings us to the third important takeaway—there are at least eight universal health-care systems that perform better than we do (according to the Commonwealth Fund), and they all do universal health care differently than us.
The U.K. (ranked 1st) has a robust private-parallel system (548 private hospitals and almost 600 private clinics) that not only acts as a pressure valve but has often been tapped to try and help solve the wait times issues in the public system.
Australia (ranked 2nd) allows duplicate private insurance for expanded choice, accommodation and faster access. And delivers care through a mix of public, private not-for-profit and for-profit hospitals.
The Netherlands (ranked 3rd) ensures universal insurance coverage through a competitive (but regulated) private insurance market where individuals are mandated to purchase a basic benefit plan (subsidies are provided for vulnerable populations).
Cost-sharing for core medical services is also a standard expectation of patients in almost every universal health-care system in the commonwealth fund’s comparison (except the U.K.). Hospitals in most countries are also generally paid on the basis of activity, in contrast to the global budgets common in Canada.
The point is that universal health-care systems that perform better than Canada all incorporate a number of policies that are almost taboo to mention when discussing health-care reform in our country.
But I agree with Minister Philpott on one thing—the hashtag in her tweet. There’s clearly #muchmoretodo, and we should start by understanding there are better ways to do universal health care.
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