A Sickly Health Result

Worth A Look, Healthcare & Welfare, Frontier Centre

It’s no surprise that a new study of halfa-dozen rich countries’ health systems shows the U.S. leading the pack on costs, but dead last on results.

It has been the same story for three years running in a series of studies by the Cumberland Fund. And plenty of other research also demonstrates beyond doubt that Americans get too little bang for their very big health-care bucks.

Canadians may be more surprised — although we shouldn’t be — by a lessreported aspect of the Cumberland studies: For the third straight year, our health care was found to be the secondmost expensive and to produce the second-worst results.

This, too, is sadly predictable — although a huge number of Canadians cloak themselves in wilful denial, hiding behind fatuous rhetoric about “the best health-care system in the world.”

Good grief! Canada trails the U.K., Australia, New Zealand and Germany, even on equity — i.e. access for poor people to all health services, including things such as dental care that aren’t publicly funded, and an area where I’ve always believed we do a praiseworthy job. The analysis shows rich Canadians are bedeviled by waiting lists as often as the poor, but poor people are two or three times more likely to be deterred by cost from visiting a doctor, getting recommended follow-up care, filling a prescription, or getting teeth fixed.

Seven years ago, when the World Health Organization did its first and last comprehensive ranking of national health-care systems, Canada finished a ho-hum 30th — just behind Morocco. (The U.S. did even worse, in 37th place, sandwiched between Costa Rica and Slovenia.)

And I recall looking as long as a decade ago at numbers showing that, at the time, the U.S. had the poorest cost-toresults ratio on any nation with a privately funded health-care system, and Canada had the worst ratio among publicly funded plans. The costeffectiveness of both systems has deteriorated since then, so, unless some other countries got really bad really fast, those are dubious distinctions that I suspect we still hold.

In the Cumberland Fund study, Canada fared particularly badly in quality of care — both the overall category, where we were rated fifth of six, and in four subsets. We were worst for getting appropriate treatments, getting co-ordinated treatments, and getting patient-centred care, and we edged ahead of only the U.S. in getting safe treatments.

We were fifth of six in access — defined as timely care, as equity is a separate measurement — and in efficiency.

Canada’s only modestly respectable showing was in the one area where the main factor may be personal responsibility, not the amount or quality of care we receive from “the system.” We were were third of six in the rankings for living healthy lives.

And the cost? The United States — the wealthiest country in the study — spent a whopping $6,102 US per capita on health care in 2004, the year on which spending comparisons are based.

Canada’s $3,165 US was considerably lower, but still ahead of Germany ($3,005), Australia ($2,876), the U.K. ($2,546) and New Zealand ($2,083) — all the countries that beat us on results.

As a percentage of GDP per capita — in other words, the portion of our wealth we spend to be healthy — Canada was, as it is on most such lists, in the middle of the pack with 9.9 per cent. That’s a lot less than the 16 per cent spent by Americans, but just a little less than Germany and a little more than Australia, New Zealand or the U.K.


hear lots of railing by self-styled defenders of Canadian Medicare against those who’d Americanize our healthcare system, although very few voices actually call for that to happen. It seems critics of almost any proposed change to the system just brand it an American idea, then flail away — regardless of how well a concept like private delivery of publicly funded services may be working in more cost-effective and betterperforming jurisdictions than ours.
But I agree with the critics to the extent I think we’d be nuts to import the U.S. system’s built-in costs and dysfunctionality. It’s an idea that could only be supported by someone as ideologically hog-tied as those who pretend our system has created a northern Nirvana and must not be altered in any substantive way.

Except, of course, to be fed more money.