Canada spends more on health care than most European and Asian nations but has some of the longest waiting times and worst access to physicians in the world, concludes a report comparing 27 countries that all guarantee access to health care, regardless of ability to pay.
Nations such as Sweden, Japan, France and Australia outperform Canada in keeping women with breast cancer alive, the number of years people can expect to live without a disability, preventing death from disease and waiting times for health services.
“Canadians continue to not get value for their money,” said Nadeem Esmail, co-author of the report, released yesterday by the Fraser Institute think-tank.
“We are spending a huge amount of money and getting terrible wait times, inferior access to technology and mediocre health outcomes.”
Canada ranks in the bottom half of nations in patient access to mammograms, CT scanners and MRI machines, technologies that are routinely used to detect cancer.
Canada also has fewer physicians than other industrialized nations: It ranks 24th among 27 nations, with 2.3 doctors per 1,000 people. In 1970, by comparison, the year public insurance was first fully applied to services from physicians, Canada had the second-highest number of physicians per capita.
Iceland boasts almost twice as many physicians per capita than Canada, while nations such as Italy, Germany, France and Finland all have significantly more than Canada.
The report found that of the 27 countries, only Canada outlawed a parallel private system while others with universal health care, such as Sweden, Japan and Australia, allow some mix of user fees, private insurance and private hospitals to compete for patient demand.
“They allow patients the freedom to see care on their own terms if the public system is unwilling or unable to meet their needs,” said Mr. Esmail, a senior health policy analyst at the Vancouver-based Fraser Institute.
Canada is one of only four countries with universal care that spends more than 10% of its GDP on health. Only Iceland and Switzerland spend more than Canada.
But Albert Schumacher, president of the Canadian Medical Association, said Canada has some good reasons for spending more than most European countries, such as the cost of serving remote areas and the complex health needs of aboriginals, immigrants and refugees.
“None of these countries has jet fuel as a major health care expenditure,” Dr. Schumacher said. “If we moved the rest of the country into Southern Ontario, we would have a very effective health care system.”
And he suggested better health outcomes in some of the European countries could be due to increased social spending in other areas, such as lengthy maternity leave, subsidized child care, shorter work-weeks and longer vacations.
Still, Dr. Schumacher, a family physician in Windsor, Ont., agreed with the report’s conclusions that Canadians’ access to physicians and technology lags behind the rest of the industrialized world.
All figures in the Fraser Institute report are adjusted for the age of the population to reflect the fact that patients older than 65 consume the majority of health services. In Canada, for example, those 65 and older make up less than 13% of the population, but consume more than 44% of health care expenditures.
The United States was excluded from the report because health care in that country, for the most part, is not government-funded.
The international comparison also found that countries that outperform Canada in keeping diseased patients alive all have private alternatives to the public system and all charge user fees.
Canada, for example, ranks 20th in infant mortality and 22nd in the percentage of total life expectancy that will be lived in full health.
“The government’s solution lately seems to be dumping more money into the system,” said Mr. Esmail, noting that waiting lists continue to swell despite cash infusions from the federal and provincial governments.
In September, 2004, Paul Martin, the Prime Minister, promised $41-billion in new health care spending, over 10 years, in response to the premiers’ concerns about ballooning health care budgets.
Patients waiting for hip and joint replacement, for example, faced average waits of more than seven months in Ontario in 2004, the province that has the most extensive data on waiting times. Getting a consultation with an orthopedic surgeon in London, Ont., for example, takes at least a year, followed by an 18-month wait for surgery.
Waits are similar in British Columbia and Quebec and only slightly shorter in Alberta. In Nova Scotia, average waits are more than a year and half. And those numbers do not include the months patients wait to get an appointment with an orthopedic surgeon; many refuse to see new patients after waiting lists reach two years.
Part of the problem is bad management, concludes Michael Dunbar, a Halifax orthopedic surgeon who has studied waiting times at his hospital.
Patients could be served right away, for example, if hospitals had the money to pay nurses overtime. All elective surgeries at North York General, for example, a major hospital in suburban Toronto, must be scheduled between 7:30 a.m. and 3:30 p.m. At Halifax’s QEII Health Sciences Centre, surgeries that could go past 5:30 p.m. are cancelled, sending a team of orthopedic surgeons, anesthesiologists and nurses home with nothing to do and leaving the operating room empty.
Boyd Stewart, president of the Saskatchewan Medical Association, says most doctors in his province do not believe their former premier, Tommy Douglas, ever intended universal health care to cover all the services it does today.
“Everyone says, ‘Oh Tommy Douglas wanted everything free,'” says Dr. Stewart, a family physician in Weyburn, a town in the southeast corner of the province.
“But that doesn’t make sense. It’s not sustainable. These other countries have figured that out and we need to learn from them and come up with our own made-in-Canada solution.”
He noted that other than Canada, the only other countries he knows that have outlawed private medicare are Cuba and North Korea.
“That’s not very good company.”