How does Canadian health care compare?
A recent report describes how Canada’s healthcare system performs compared to 13 other countries.
Canada ranked at the bottom in access to care and use of electronic health records, and in the middle regarding costs and health outcomes.
Thirty-eight percent of Canadians felt the system works well, 51% thought it needs fundamental change, and 10% believed it needs to be completely rebuilt.
A recent report from the American organization The Commonwealth Fund provides information about how Canada’s health care system compares to those in thirteen different high-income countries. Some of the findings are summarized here.
Access to Care
Canada consistently ranked poorly on access to care. In Canada, wait times were longer than in any of the other country for specialist appointments and elective surgeries. For example, 41% of Canadians waited two months or more to see a specialist, compared to just 5% of Swiss and 7% of Germans. One in four Canadians waited four months or more for elective surgery, compared to none in Germany and 5% in the Netherlands.
Canada was the second worst country for accessing health care after hours. Sixty-five percent of Canadians report that it is very or somewhat difficult to find care after regular business hours, compared to 33% of people in the Netherlands.
This poor performance has occurred even after the federal government commited $4.5 billion to reduce wait times in 2004, as well as major investments by the provinces. Stephen Duckett, an Australian health economist and former CEO of Alberta Health Services says that “the waiting list money was highly targeted at specific services, such as hip replacements” and that other countries like the United Kingdom have been able to reduce wait times by setting up aggressive targets for providers and penalties if the targets were not met. At the same time, funding for health care was markedly increased in the UK.
Electronic Medical Records
While significant investments have been made to increase the number of primary care providers, Canadian primary care doctors had the lowest use of electronic medical records in their practices – 37% in Canada, 46% in the United States, and above 90% in seven countries.
The poor uptake of electronic medical records in primary care has occurred despite considerable investments in eHealth provincially and nationally. Tom Noseworthy, a Professor of Community Health Sciences at University of Calgary argues that there was “an insufficient investment in [electronic medical records] Canada-wide that did not operate from a careful blue print on how to achieve gains in every province” leading to a situation where “there are little pockets of doctors using electronic medical records that do not connect as a whole”.
Duckett believes that “the introduction of electronic health records is much more complicated in primary care because of the disorganized nature of primary care, as opposed to the hospital sector.
The report also includes measures related to hospitals. Canada had the fewest acute care beds per population and the highest average length of stay (7.7 days). This information suggests that few Canadians are being admitted to hospitals unnecessarily, which is a good thing. However, the lack of hospital beds for acutely ill patients is a major cause of emergency department overcrowding, and our long wait times for some surgical procedures suggest that more hospital beds are needed to accommodate these procedures.
However, this may not require the construction of more hospital beds, because about 14% of hospital days in Canada are currently taken up by patients who no longer need acute care. Investments in community and long-term care might help the hospital sector. Noseworthy believes that “it is a good thing that Canada has been able to get by with so few acute care beds” and that in spite of the low numbers of beds, they are still “not being used optimally.” He suggests that “we do not have good substitutive services, leaving acute care beds as the only port in the storm for sick patients who could receive care in less acute, sub-acute or intensive home care environments.”
Costs of Health Care
All countries in the report had some form of publicly funded health care paid by government revenues from taxes. However, the amount spent on health care varied markedly. Canada was in the middle of the pack when it comes to the percentage of gross domestic product (GDP) spent on health care. The United States spent by far the most at 17.4%, and Japan spent the least at 8.5%. Canada was similar to countries like Denmark, France, Germany and Switzerland, and spent 11.4% of annual GDP on health care in 2009.
Canada’s proximity to the United States means that we often compare our health care system with our neighbour to the south. However, as mentioned above, the United States spent by far the most on health care of any country, and its measures of quality were frequently among the worst and rarely among the best (except for access to specialists and surgeries). We might gain valuable insghts by carefully looking at the health care systems of other countries.
Public Satisfaction with Health Care
While performing poorly in terms of access to care and the use of electronic health records, Canada was average in survival after a heart attack and was in the top two performing countries in survival after the diagnosis of breast cancer and the frequency of a lower-limb amputation in persons with diabetes. Given this mixed picture in performance, it is not surprising that Canadians were far from unanimous in their views about the need for change in the health care system – 38% felt the system worked well with only minor changes needed; 51% felt that fundamental changes were needed, and 10% felt that the health care system needed to be totally rebuilt.
These numbers are similar to most of the other countries. The greatest desire for change was expressed by citizens in Australia and the United States, with 20 and 27% respectively saying that their health care system needed to be totally rebuilt. The United Kingdom was on the other extreme, with 62% of citizens feeling that the system worked well, and only 3% indicating that the system needed to be totally rebuilt.