Read this report before you slag Canada’s healthcare system

TheStar.com – news/Canada/politics
Published Wednesday, May 18, 2011.   By Thomas Walkom, National Affairs Columnist

A new report suggesting that Canadians don’t get much bang for their health dollar is making headlines. So far, the reaction has been predictable.

Critics of medicare say the Conference Board of Canada report shows that our universal health care system doesn’t work. Writing in the Edmonton Journal, commentator Lorne Gunter blamed what he called Canada’s poor showing on the government’s “monopolistic control” over health care. The National Post opined that only more privately funded health care (also known as two-tier medicine) could rectify the problem.

Both were reacting to a news release accompanying last week’s report. The release points out that among 17 developed nations, Canada scores fourth in per capita spending on health care but only 10th in terms of what the board calculates — on the basis of indicators such as life expectancy — to be overall performance.

This skillfully provocative press release ensured that the study was reported across the country. It also played into the increasingly common narrative that Canadian medicare is broken.

Alas, it’s too bad so few bothered to read the study itself. For it’s rather good. Contrary to the headlines, it doesn’t slag medicare. In fact, it doesn’t much focus on Canada.

Rather, it deals mostly with the puzzle of the United States. Why is it that the country which spends 50 per cent more on health than any other advanced nation gets such poor results?

America is truly the outlier. It spends about 16 per cent of its gross domestic product on health care. Most other developed nations (including Canada) spend in the neighbourhood of 10 per cent. A few, including Japan, Australia and Norway, are closer to 8 per cent.

Yet the U.S. routinely scores worst in most basic health indicators — including life expectancy and infant mortality. Why?

The report doesn’t give a definitive answer. But it does zero in on two elements that Canadians may find useful.

First, it makes the obvious point that health involves more than doctors, hospitals and drugs. It suggests that Japan’s high life expectancy is related more to diet than anything else (the Japanese are far less obese than Americans).

And it points out that the countries with some of the worst health outcomes are often those with the most poverty.

That Canada has the second-highest level of infant mortality among advanced nations may have little to do with our health care system and much to do with the fact that our poverty rate is almost as high as America’s.

The second question the Conference Board looks at is why U.S. medical costs are so high.

Its findings here won’t give much solace to the National Post.

The study attributes much of this extra spending to America’s reliance on private medical insurance. Administration costs in the United States are twice those of its nearest competitor, France.

Incidentally, Canada already has the third-highest rate of private health spending among the countries surveyed, a fact that should give pause to those who claim that privatization leads to lower costs.

The study also fingers another panacea of the right: market incentives. It notes that outpatient surgery and diagnostic testing in the U.S. are skyrocketing — in part because pricey tests (such as MRI scans) are needlessly duplicated and in part because fee-for-service billing encourages specialists to schedule more operations.

Canada doesn’t get off scot-free. The report’s authors say we are losing ground on diabetes and lagging in mental health.

But overall, the Conference Board report doesn’t concentrate on medicare. It says we should deal with poverty, eat more vegetables and be more active. All good advice.

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