canadian health care

Printer-friendly version
Comparing Performance of Universal Health Care Countries, 2017

Comparing the performance of different countries’ health-care systems provides an opportunity for policy makers and the general public to determine how well Canada’s health-care system is performing relative to its international peers. Overall, the data examined suggest that, although Canada’s is among the most expensive universal-access health-care systems in the OECD, its performance is modest to poor.

This study uses a “value for money approach” to compare the cost and performance of 29 universal health-care systems in high-income countries. The level of health-care expenditure is measured using two indicators, while the performance of each country’s health-care system is measured using 42 indicators, representing the four broad categories: [1] availability of resources; [2] use of resources; [3] access to resources; [4] quality and clinical performance.

Five measures of the overall health status of the population are also included. However, these indicators can be influenced to a large degree by non-medical determinants of health that lie outside the purview of a country’s health-care system and policies.

Expenditure on health care
Canada spends more on health care than the majority of high-income OECD countries with universal health-care systems. After adjustment for “age”, the percentage of the population over 65, it ranks third highest for expenditure on health care as a percentage of GDP and eleventh highest for health-care expenditure per capita.

Availability of resources
The availability of medical resources is perhaps one of the most basic requirements for a properly functioning health-care system. Data suggests that Canada has substantially fewer human and capital medical resources than many peer jurisdictions that spend comparable amounts of money on health care. After adjustment for age, it has significantly fewer physicians, acute-care beds, and psychiatric beds per capita compared to the average of OECD countries included in the study (it ranks close to the average for nurses). While Canada has the most Gamma cameras (per million population), it has fewer other medical technologies than the average high-income OECD country with universal health care for which comparable inventory data is available.

Use of resources
Medical resources are of little use if their services are not being consumed by those with health-care demands. Data suggests that Canada’s performance is mixed in terms of use of resources, performing at higher rates than the average OECD country on about half the indicators examined (for example, consultations with a doctor, CT scans, and cataract surgery), and average to lower rates on the rest. Canada reports the least degree of hospital activity (as measured by discharge rates) in the group of countries studied.

Access to resources
While both the level of medical resources available and their use can provide insight into accessibility, it is also beneficial to measure accessibility more directly by examining measures of timeliness of care and cost-related barriers to access. Canada ranked worst on four of the five indicators of timeliness of care, and performed worse than the 10-country average on the indicator measuring the percentage of patients who reported that cost was a barrier to access.

Quality and clinical performance
When assessing indicators of availability of, access to, and use of resources, it is of critical importance to include as well some measure of quality and clinical performance in the areas of primary care, acute care, mental health care, cancer care, and patient safety. While Canada does well on four indicators of clinical performance and quality (such as rates of survival for breast and colorectal cancer), its performance on the seven others examined in this study are either no different from the average or in some cases—particularly obstetric traumas and diabetes-related amputations—worse.

The data examined in this report suggests that there is an imbalance between the value Canadians receive and the relatively high amount of money they spend on their health-care system. Although Canada ranks among the most expensive universal-access health-care systems in the OECD, its performance for availability and access to resources is generally below that of the average OECD country, while its performance for use of resources and quality and clinical performance is mixed.

Private health care isn’t the problem—it’s part of the solution

In 2016, patients in Canada could expect to wait 20 weeks between GP referral and treatment.

Printer-friendly version

 

Comparing the performance of different countries’ health-care systems provides an op-portunity for policy makers and the general public to determine how well Canada’s health-care system is performing relative to its international peers. Overall, the data ex-amined suggest that, although Canada’s is among the most expensive universal-access health-care systems in the OECD, its performance is modest to poor.

This study uses a “value for money approach” to compare the cost and perfor-mance of 28 universal health-care systems in high-income countries. The level of health-care expenditure is measured using two indicators, while the performance of each country’s health-care system is measured using 42 indicators, representing the four broad categories:

  • availability of resources
  • use of resources
  • access to resources
  • quality and clinical performance

Five measures of the overall health status of the population are also included. However, these indicators can be influenced to a large degree by non-medical determinants of health that lie outside the purview of a country’s health-care system and policies.

Expenditure on health care
Canada spends more on health care than the majority of high-income OECD countries with universal health-care systems. After adjustment for age, it ranks third highest for expenditure on health care as a percentage of GDP and fifth highest for health-care ex-penditure per capita.

Availability of resources
The availability of medical resources is perhaps one of the most basic requirements for a properly functioning health-care system. Data suggests that Canada has substantially fewer human and capital medical resources than many peer jurisdictions that spend comparable amounts of money on health care. After adjustment for age, it has signifi-cantly fewer physicians, acute-care beds and psychiatric beds per capita compared to the average OECD country (it ranks close to the average for nurses). While Canada has the most Gamma cameras (per million population), it has fewer other medical technologies than the average high-income OECD country with universal health care for which comparable inventory data is available.

Use of resources
Medical resources are of little use if their services are not being consumed by those with health-care demands. Data suggests that Canada’s performance is mixed in terms of use of resources, performing higher rates than the average OECD country on about half the indicators examined (for example, consultations with a doctor, CT scans, and cataract surgery), and average to lower rates on the rest. Canada reports the least amount of hospital activity (as measured by discharge rates) in the group of countries studied.

Access to resources
While both the level of medical resources available and their use can provide insight into accessibility, it is also beneficial to measure accessibility more directly by examining measures of timeliness of care and cost-related barriers to access. Canada either ranked last or close to last on all indicators of timeliness of care, but ranked in the middle on the indicator measuring the percentage of patients who reported that cost was a barrier to access.

Quality and clinical performance
When assessing indicators of availability of, access to, and use of resources, it is of criti-cal importance to include as well some measure of quality and clinical performance in the areas of primary care, acute care, mental health care, cancer care, and patient safety. While Canada does well on four indicators of clinical performance and quality (such as rates of survival for breast and colorectal cancer), its performance on the seven others examined in this study are either no different from the average or in some cases—particularly obstetric trauma and diabetes-related amputations—worse.

The data examined in this report suggests that there is an imbalance between the value Canadians receive and the relatively high amount of money they spend on their health-care system. Although Canada has one of the most expensive universal-access health-care systems in the OECD, its performance for availability and access to re-sources is generally below that of the average OECD country, while its performance for use of resources and quality and clinical performance is mixed.

On health-care reform, Trudeau should finish what Chretien started

The federal health minister seems aware that policy innovation—not more money—is necessary to improve Canadian health care.
Printer-friendly version
Less Ottawa, More Province: How Decentralization Is Key to Health Care Reform

Despite high levels of public spending, Canada’s health-care system consistently performs more poorly than a number of peer jurisdictions with universal health-care systems. Governments across the country must address this policy challenge in a context of constrained resources, as the federal government and a number of provinces currently face increasing debt loads and other significant fiscal challenges. This paper considers the extent to which policy lessons from Canada’s past can help governments in Canada address the dual challenges of an underperforming health-care system and growing fiscal pressure on governments. Specifically, it considers the extent to which Canada’s experience with reform of federal-provincial transfers and welfare during the 1990s provides lessons that can be applied to the process of reforming Canadian health care.

During the 1990s, the federal government transformed its approach to providing financial assistance to the provinces to support their welfare and social assistance programs. Specifically, the federal government reduced transfers to the provinces but, in exchange, removed a number of “strings” previously been attached to federal funding that prohibited certain types of policy reform. For example, the provinces were permitted to create work requirements for receipt of welfare payments, which previously would have triggered the withholding of federal transfers.

The reform of federal transfers to the provinces led immediately to a wave of policy innovation and reform at the provincial level, as governments across the country pursued various policy paths designed to improve their welfare programs, create solutions that actually addressed local problems, and reduce program costs. Many of these reforms had the intended effects, as there was a marked decline in welfare dependency and government spending on public assistance in subsequent years.

However, no similar wave of policy innovation occurred following the 1990s transfer reforms in Canadian health care. This is largely because the government maintained the various “strings” that were attached to health spending transfers and, specifically, the terms and conditions of the Canada Health Act. As a result, health-care policy in the Canadian provinces has since the 1990s generally been largely characterized by policy inertia while spending on health care has increased considerably.

Canada’s experience with welfare reform provides a model with important implications for how to begin reforming and improving Canadian health care. By reducing transfers in real terms while amending specific provisions of the Canada Health Act that inhibit reform, the federal government can partially address the fiscal challenges it faces today while providing provinces with the freedom to innovate and pursue policy reforms to improve their health-care systems.

Such changes would allow for greater experimentation by each province as they seek out what policy arrangements have the best possibility of improving health-care performance. For instance, provinces would be well served to examine the introduction of cost-sharing arrangements (co-insurance, deductibles, and co-payments) used in most other universal health-care countries to ensure more efficient use of the health-care system by patients. Provinces might also look at removing regulations that currently prevent a greater supply of needed health-care professionals and investment within the health-care sector.

It is uncertain exactly what reforms different provinces would choose and this paper does not weigh the advantages and risks of specific reform options in detail. Instead, based on Canada’s experience with welfare reform, this paper recommends a crucial change, the devolvement of decision--making powers to the provinces, with the federal government permitting each province maximum flexibility (within a portable and universal system) to provide and regulate health-care provision as they see fit.

Misinformation fuels opposition to health-care reform in Canada

Our health-care system is expensive, delivers poor-to-modest results, and fails to achieve many of its laudable aspirations.

Do you know how much you pay for health care?

The average unattached Canadian will pay about $4,257 this year, while an average family of four will pay $11,494.
Subscribe to RSS - canadian health care