In a new study of health care in 11 affluent countries, Canada placed ninth overall, only ahead of France and the United States. Run by the Commonwealth Fund, a New York-based private research foundation, the score reflects Canada’s failure in aspects such as infant mortality, access to after-hours medical care and the affordability of dental visits and prescription drugs.
Marginally better than the 10th place finish in 2014, Canada still falls well behind the scores of the United Kingdom, Australia, and the Netherlands. The report listed the following rankings:
1) United Kingdom, 2) Australia, 3) Netherlands, 4) New Zealand and Norway (tied), 6) Sweden and Switzerland (tied), 8) Germany, 9) Canada, 10)France, 11) United States
It does catch some people by surprise, especially because Canada is often referred to in the fight for universal health care in the United States. According to the Commonwealth Fund, Canada also spends more on their health care system than the higher-ranked UK, Australia, New Zealand, and Norway when compared as a percentage of the GDP.
The Commonwealth Fund is one of the few organizations that systematically grades and compares the health care systems in high-income countries. Generated with an American audience in mind, their Mirror Mirror report offers more suggestions on how to improve the abysmal US health care compared to other nations, but also reveals glaring weaknesses in Canada's system. Canadian politicians often use this comparison when discussing policy changes and budgeting purposes when it comes to our health care.
The document makes it clear that Canadians are not getting value for the money spent. According to the study, which relies on 72 metrics grouped into five categories (Care Process, Access, Administrative Efficiency, Equity and Health Care Outcomes), Canada fell short with a higher infant mortality rate, the prevalence of chronic conditions, long wait times for specialists and emergency care, poor after-hours care, and a lack of reliable coverage for things like dental work and prescription drugs.
“The domains that put Canada in ninth place are really access, equity and health-care outcomes,” said Eric Schneider, senior vice-president for policy and research at the Commonwealth Fund. “On those domains of quality, [Canada] is fairly similar to the US.”
For any American readers, I’d recommend this beautifully quick summary of our single payer system from Healthcare Triage to get caught up on what I’m about to rant about. As a Canadian, our low ranking comes as no surprise. I have been waiting 3 and a half months to see a specialist for a digestive issue, whose office assures me that this was the earliest appointment available. Ask most Canadians, and you’ll hear plenty of complaints, especially from anyone more than an hour outside of a major city. Don’t get me wrong; I’m still extremely grateful and lucky to live in a country where our health care is “free.” We don’t have politicians constantly trying to take it away or anything, but what this report brings to light is something that we really need to start acknowledging. Every other developed country in the world has a single payer system similar to Canada’s, so it’s time to stop bragging about Tommy Douglas and start wondering why our universal health care system is so bad compared to everyone else’s.
Let’s break it down. Canada’s system ranked in at the following:
- Access - 10
- Administrative efficiency - 6
- Equity - 9
- Healthcare outcomes - 9
- Care process – 6
Access covers two sections: affordability and timeliness. With the wait times that we have, it is no surprise that we finished near the bottom in this category. Logistically, it’s also difficult to have enough facilities in the non-urban centers to try and cut down the lack of access to medical staff. I know there are some ideas floating around right now about online consultations, but realistically, there isn’t much that can be done because of the vast areas that would need to be covered. Canada needs to focus on cutting down on wait times for its population to score better in this aspect.
Administrative efficiency measures how available doctors are to see patients, and how efficient the rest of the staff is in dealing with paperwork and proper documentation. According to the study, most low-scores in this area were due to patients and doctors spending time fighting insurance companies. This isn’t as much of a problem in Canada with our single-payer system, so go us. But on that note, with several key health aspects not covered by federal or provincial programs, gaps have resulted for things that are essential to overall health, such as vision care or coverage of various drugs. Equity measures the difference between the health levels of higher-income and lower-income individuals. The lower the difference, the higher the level of equity. With an unemployment rate of around 6.5%, Canada isn’t fairing too badly overall in that aspect, but with most jobs available being contract or part-time, Canadians are having a much tougher time finding supplemental insurance through their employers to cover the difference. Hell, just last month employees of the Crown corporation LCBO were on the verge of a strike over alleged mistreatment, such as being restricted to four-hour shifts a day. Although several provinces have made the leap to raising minimum wage to $15/hour, this low equity score can be directly linked to the rough job market. And that’s not something rearranging finances in health care can fix.
Healthcare outcomes measure the percentage of people that are properly treated and kept alive with timely and systematic healthcare resources. This ties directly into the access issue, so it only makes sense we’ve done so poorly in this category as well. Of course, don’t freak out about the infant mortality rate. Canada is sitting at 4.8 deaths for every 1,000 live births; losing an infant is a sad thing, but I think a 0.004% rate is doing pretty well. And I think that’s part of the problem. Some of the report’s indicators are relatively small, but when placed on a ranking system end up making things seems abysmal. 16% of Canadians reported having at least two of five common chronic conditions, but we ranked near the top for five-year survival rates for colon and breast cancer. And that brings us to our relatively decent score in care process. Care process is essentially how well and to what standard the patients are being treated. It’s a measure of not only how well a health care system works as a whole, but also how well trained doctors and medical staff are.
I can only hope our government is paying attention this time around. This report is a great indication and reflection of what improvements need to be made. Canada is still a great country, but it’s about time we start admitting the fact that we are not even close to being the gold standard for health care. But no success story is complete without a failure or two along the way. In the business world, leaders are often told: “fail fast, fail early, fail often.” In order to innovate, to improve, we must accept our failures. Most importantly, we need to learn from them. The Canadian health care system is not currently the best, but it could be once we start acknowledging its shortcomings and start addressing the problems our population is facing.