The release this week of a major new health-care “report card” provides us with the opportunity to refocus the debate that surrounds the effects of Canada’s ongoing health-care woes on consumers.
The focus of the debate so far has been on how health care is financed, how to budget for it and, most recently, how to fill the doctor gap. We have seldom considered the system from the more important perspective of the health-care consumer.
The Euro-Canadian Health Consumer Index (ECHCI), which was released on Monday, takes a fresh look at how medicare serves Canadians. The results are dismal. Of the 30 countries studied, Canada ranks 23rd for consumer sensitivity in health care.
The index is built around a central question: “How well are the needs of consumers being met?” Since 2005, Stockholm/Brussels-based Health Consumer Powerhouse (HCP) has been evaluating and ranking health care in Europe. This year, HCP joined with the Frontier Centre for Public Policy to include Canada in the index.
When it comes to patient rights and providing the health-care consumer with information, Canada lags far behind most of Europe. Because our system is oriented toward providers rather than users, consumers lack meaningful guarantees of timely and effective treatment. Successful European health-care systems include strong “patient rights” laws, something Canada lacks. Without these rights laws, as well as the right to a second opinion, unrestricted access to our own medical records and ready information about the qualifications and histories of doctors, Canadians are treated as passive patients rather than empowered consumers.
Nowhere is this more apparent than with regard to waiting times. It is not news that waits for diagnosis and treatment are unacceptably long in Canada. It is sobering, however, to find out that we finish at the very bottom of the index in this area. Changing to a performance-based pay system would ease waiting times considerably.
Canadian medical outcomes compare more favourably. The 30-day mortality rate for Canadian patients who suffered a heart attack is a very low 11.1 per cent, which indicates excellent treatment in hospitals. For infant mortality and cancer five-year survival rates, we are in the middle of the pack.
One indicator used to gauge the generosity of a health-care system is cataract surgery, an affordable elective procedure. Canada scores the highest mark possible in this area. Other areas of Canadian health care, though, demonstrate that, overall, Canada provides much less to its citizens than most European states.
In pharmaceuticals, Canada performs poorly. While the top-ranked health-care states in Europe provide public funding for over 90 per cent of all spending on drugs, we publicly finance just 38 per cent of prescription costs, giving us a failing grade for this indicator. However, price is not the only obstacle to accessible pharmaceuticals for Canadians. Most provinces lack a publicly available formulary that explains in layman’s terms what drugs are covered and under what circumstances. While access to new cancer-fighting drugs is about average compared to Europe, new drugs in general are available in Canada for over a year before they are eligible for public funding. One approach to improving access and outcomes might be to lower the ceiling for drug subsidies and promptly include effective new drugs in the formulary.
Apart from the few bright spots such as heart attack mortality and cataract surgery, Canada’s performance falls consistently between poor and adequate, as its rank of 23rd out of 30 implies. In fact, all of the countries that Canada outperforms are rehabilitated former east bloc states.
The index includes a bang-for-the-buck metric, which assesses each country’s performance in the context of how much each country spends on health care per capita. From this perspective, Canada falls to the very bottom, getting the least value for money of all 30 countries analyzed.
The index is undeniable proof that Canada has much to improve upon. The Euro-Canada Health Consumer Index, the first attempt to compare Canada with Europe in terms of meeting the needs of health-care consumers, shows that we do a mediocre job of fulfilling our commitment to excellent and accessible health care. Austrians, the French and the Dutch enjoy better and more accessible health care than we do and at a lower per capita cost. There is no reason Canada cannot improve and reach a similar level, and the release of the index marks an important new tool to use to reach this end.