Social Policy in Ontario

It’s election season in Ontario and if the recent Speech from the Throne and NDP platform are any indication, health care is a key issue on the minds of political parties and voters.

This should come as no surprise for even casual observers of Ontario politics, with recent announcements by the provincial governments for more money for hospitals, mental health and drugs coverage, along with opposition platform commitments to pharmacare and expanded dental coverage.

As we enter into the campaign, Ontarians will likely hear about how our health care system is underfunded, wasteful, inefficient and poorly performing. But is it true?

A recent study in the Journal of the American Medical Association compared health spending, system utilization and performance of 11 high income countries, including Canada. While the main findings, unsurprisingly, were that the United States spends far more on health care than its peers, there were some important findings that are timely and relevant for Canadians. While this data is national, not provincial, there are four conclusions relevant for Ontarians as they are bombarded by political rhetoric over the next three months.

1. Canada’s spending on health care is near the bottom of the pack.

Contrary to what we’ve been told by political pundits, Canada spends 10.3 per cent of GDP on health, well below the mean of 11.5 per cent of GDP. Public spending on health is 7.4 per cent of GDP, or second to last. At 4,641 (U.S.)/capita, we spend well below the mean of $5,461 (U.S.)/capita, and less than half of what the U.S. spends per capita.

2. Canada has fewer doctors and nurses than most countries.

Overall, Canada has the third fewest doctors and nurses of the 11 countries surveyed. Interestingly, Canada has the third highest number of doctors in urban areas, but fewest in rural areas. Canadian doctors and nurses are relatively well paid, with generalists being the third highest paid, specialists fourth highest paid and nurses fifth highest paid. Context in this case matters. U.S. physicians and nurses are far and away the highest paid, and taking into account how easy it is for Canadian professionals to migrate south, I would have expected compensation in Canada to be higher.

3. Finding “efficiencies” in the health system will be difficult.

Every political party has confidently stated they can “cut the fat” from the system, but the data would suggest Canadian health care is already administratively lean. Spending 3 per cent of the health-care budget on administration, Canada currently sits 6th of 11 countries and spends less than half of what the U.S. spends on administration. Canada also has the second fewest hospital beds per 1,000 population and has the fewest bed days per in-patient. There is always more that can be done to make health care even more efficient, particularly reducing unnecessary tests and treatments, but cutting health administration will not get the gains politicians think.

4. Canada has work to do to improve care for everyone.

Despite universal health coverage, equitable access to care is a problem in Canada. Canada ranks second highest in terms of inequity, with the third highest rate of poverty, after the U.S. and Japan. Social program spending, such as housing benefits and income supplements, which have been shown previously to improve health outcomes for disadvantaged people, is lowest in Canada, at only 13 per cent of GDP.

Finally, does Canada get value for the health-care dollars it spends? Our health adjusted life expectancy ranks 4th, we have some of the lowest rates of avoidable hospitalizations for common chronic diseases, as well as low mortality rates after a heart attack. It should come as no surprise that our wait times remain among the highest of the countries surveyed to see a family doctor and specialist.

So while our outcomes compare well internationally, Canadians wait far too long for care, particularly in rural regions of the country. So during this campaign season, when political rhetoric is at a fever pitch, hopefully data like this can help politicians guide Ontarians to the care they deserve.

Dr. Sacha Bhatia is the F.M. Hill Chair in Health Systems Solutions at Women’s College Hospital, as well as a cardiologist at Women’s College Hospital and University Health Network.

https://www.thestar.com/opinion/contributors/2018/04/04/before-voting-understand-these-facts-about-heath-care.html