Top dollar for bargain health care in Canada

NationalPost.com – FullComment
13/05/13. Nadeem Esmail

Canadians, having just paid their taxes, may take some solace that some of that money goes to funding a world-class healthcare system. Unfortunately, Canadians are not receiving the same sort of value that their counterparts in other nations are when it comes to universally accessible health care. This despite the fact some 68% of personal income taxes paid in aggregate are required to cover the cost of health care in this country. Canadians spend much more for their health care, and receive lower quality care than other countries with universal-access systems.

First, the cost: Canadians fund the developed world’s most expensive universal-access health-insurance system. On an age-adjusted basis (older people require more care) in the most recent year for which comparable data are available, no nation spent more than Canada as a share of GDP on a similar system. The average comparable nation spent 21% less than we did on health care. Japan, the lowest spender, spent 46% less.

Now, performance. With that level of expenditure, you might expect that Canadians receive world-class access to health care. The evidence suggests otherwise.

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Consider waiting lists. In 2012, the median wait time for treatment by a specialist was 17.7 weeks in Canada. Despite substantial spending increases over the past 15 or so years, that wait time was 49% longer than the overall median wait time of 11.9 weeks back in 1997. It was 91% longer than the overall median wait time of 9.3 weeks back in 1993.

Canada’s waiting lists are also, according to the available evidence, among the longest in the developed world. For example, a 2010 Commonwealth Fund survey of individuals in 11 nations, 10 of whom maintain universal programs, found that Canadians were most likely to wait four months or more for elective surgery; were most likely to wait two months or more for a specialist appointment; were most likely to wait six days or more for access to a doctor or nurse when sick or needing care; and were most likely to wait four hours or more in the emergency room.

Among 27 developed nations who maintain universal systems, Canada ranked 23rd in the age-adjusted number of physicians per thousand population
Meanwhile, several developed nations including Belgium, France, Germany, Japan, Luxembourg, the Netherlands and Switzerland maintain universal systems that deliver access to health care in which wait times for care are not a problem.

Access to medical technologies is also relatively poor in Canada. In a comparison of age-adjusted inventories of medical technologies undertaken for international health system comparisons, Canada ranked 15th of 24 nations for whom data was available in MRI machines per million population, and 16th of 25 nations in CT scanners per million population.

Governmental restrictions on medical training, along with a number of other policies affecting the practices of medical practitioners, have also taken their toll on Canadians’ access to care. Among 27 developed nations who maintain universal systems, Canada ranked 23rd in the age-adjusted number of physicians per thousand population.

While our taxes can and do pay for important and valuable services for all Canadians, we need to critically assess whether we are receiving full value for the dollars we are spending. In the case of health care, Canadians are paying for a world-class system but are not receiving one. Canadians must carefully consider the need for substantial reforms.

Nadeem Esmail is director of health policy research at the Fraser Institute.

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