Canada’s high healthcare spending belies modest-to-low performance

A new survey of universal healthcare systems worldwide reveals how Canada is trailing behind its global peers

Canada’s high healthcare spending belies modest-to-low performance
In the lead-up to the latest negotiations for the Canada Health Accord, Federal Health Minister Jane Philpott has repeatedly pointed out the need for healthcare performance to match spending. A new report from the Fraser Institute has put that point into sharp relief.

The study, titled Comparing Performance of Universal Health Care Countries, 2016, used a value-for-money approach to compare costs and performance among 28 universal healthcare systems in high-income countries. Two indicators were used to track the level of health-care expenditure. Performance, on the other hand, was measured using 42 indicators falling under four broad categories: availability of resources, use of resources, access to resources, and quality and clinical performance. Five measures of population health were also studied.

In terms of expenditure, Canada outspent the majority of its peers. Adjusted for age, it placed third highest in the group in terms of healthcare spending as a percentage of GDP (10.6%). The top-placed country was the Netherlands at 11%. In terms of spending per capita, Canada placed fifth at US$4,463.50, with the top country being Norway at US$5,965 per capita.

While Canada was among the leaders in spending, it lagged in terms of availability of resources, with significantly fewer physicians, acute-care beds, and psychiatric beds per capita compared to the average OECD country. It was also below average in terms of number of medical technologies (per million population), with the exception of Gamma cameras for which it had the most per million population (21.4). Access to healthcare resources in Canada was similarly poor, with the country ranking last or close to last in terms of timeliness of care, though it was average in terms of cost-related barriers.

Its report card was mixed for the other broad performance categories. With regard to use of resources, it had higher rates compared than the average OECD country in about half of the indicators – such as doctor consultation, CT scans, and cataract surgery – and average to lower rates on the rest, notably showing the least amount of hospital activity in the group of countries assessed (8,628.3 per 100,000 population). For quality and clinical performance, it does well on four indicators (such as survival rates for breast and colorectal cancer), but in the other seven indicators it did no better or, in the case of obstetric trauma and diabetes-related amputations, worse.

“Clearly, there is an imbalance between the value Canadians receive and the relatively high amount of money they spend on their health-care system,” concluded the report.

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