Canada one of highest spenders among universal health care countries, but performance ranks modest-to-low

Comparing the performance of different countries’ health-care systems provides an op-portunity for policy makers and the general public to determine how well Canada’s health-care system is performing relative to its international peers. Overall, the data ex-amined suggest that, although Canada’s is among the most expensive universal-access health-care systems in the OECD, its performance is modest to poor.

This study uses a “value for money approach” to compare the cost and perfor-mance of 28 universal health-care systems in high-income countries. The level of health-care expenditure is measured using two indicators, while the performance of each country’s health-care system is measured using 42 indicators, representing the four broad categories:

• availability of resources
• use of resources
• access to resources
• quality and clinical performance

Five measures of the overall health status of the population are also included. However, these indicators can be influenced to a large degree by non-medical determinants of health that lie outside the purview of a country’s health-care system and policies.

Expenditure on health care
Canada spends more on health care than the majority of high-income OECD countries with universal health-care systems. After adjustment for age, it ranks third highest for expenditure on health care as a percentage of GDP and fifth highest for health-care ex-penditure per capita.

Availability of resources
The availability of medical resources is perhaps one of the most basic requirements for a properly functioning health-care system. Data suggests that Canada has substantially fewer human and capital medical resources than many peer jurisdictions that spend comparable amounts of money on health care. After adjustment for age, it has signifi-cantly fewer physicians, acute-care beds and psychiatric beds per capita compared to the average OECD country (it ranks close to the average for nurses). While Canada has the most Gamma cameras (per million population), it has fewer other medical technologies than the average high-income OECD country with universal health care for which comparable inventory data is available.

Use of resources
Medical resources are of little use if their services are not being consumed by those with health-care demands. Data suggests that Canada’s performance is mixed in terms of use of resources, performing higher rates than the average OECD country on about half the indicators examined (for example, consultations with a doctor, CT scans, and cataract surgery), and average to lower rates on the rest. Canada reports the least amount of hospital activity (as measured by discharge rates) in the group of countries studied.

Access to resources
While both the level of medical resources available and their use can provide insight into accessibility, it is also beneficial to measure accessibility more directly by examining measures of timeliness of care and cost-related barriers to access. Canada either ranked last or close to last on all indicators of timeliness of care, but ranked in the middle on the indicator measuring the percentage of patients who reported that cost was a barrier to access.

Quality and clinical performance
When assessing indicators of availability of, access to, and use of resources, it is of criti-cal importance to include as well some measure of quality and clinical performance in the areas of primary care, acute care, mental health care, cancer care, and patient safety. While Canada does well on four indicators of clinical performance and quality (such as rates of survival for breast and colorectal cancer), its performance on the seven others examined in this study are either no different from the average or in some cases—particularly obstetric trauma and diabetes-related amputations—worse.

The data examined in this report suggests that there is an imbalance between the value Canadians receive and the relatively high amount of money they spend on their health-care system. Although Canada has one of the most expensive universal-access health-care systems in the OECD, its performance for availability and access to re-sources is generally below that of the average OECD country, while its performance for use of resources and quality and clinical performance is mixed.