Medicare Program Fails to Measure up to European Model

Commentary, Healthcare & Welfare, Johan Hjertqvist

Back home in Brussels after an intense lecture tour in Canada last month, I took the time to look through an impressive heap of media clippings on our very first comparison between Canadian and European health care.

Our report caused huge media and policy attention. The outdoor temperature might have been tough even to a Swede but the reception to our Euro-Canada Health Consumer Index was warm and encouraging.

What we found by including Canada into our well-established European ranking of health-care systems was that Canada cannot compete. Canada took the 23rd place out of 30, actually doing well only in the category of treatment outcomes.

When you measure the position of the patient, waiting times, the generosity of the public health-care system and access to medication, Canada flops. In these areas, Canada is comparable with the former planned-economy members of the European Union.

Even more alarming is that Canada — one of the biggest spenders among the 30 ranked countries — provides the worst value for money in health care. This means that Health Canada every year costs Canadian taxpayers billions of dollars without delivering value.

So, what do Canadians say about these assessments?

To start with, the public response to the concept of comparing the publicly funded and governed Canadian system to similar systems around Europe was positive.

The old health policy quarrel between U.S. and Canada is a dead-end; few can deny that comparing Canada to Germany, France or Sweden is more relevant, since these countries share the same values of accessible and efficient health care.

This is where our index begins a new and necessary discussion.

Would it be unreasonable to expect Canada to offer better health care to its citizens than Hungary, Latvia or Greece? And what would such improvements take?

At the same time, this perspective received a defensive but typically Canadian objection at media conferences and lectures: “It is true our waiting is long for treatments and new medicines but the outcomes are anyhow quite good – and that is the most essential thing!”

From a European perspective, such an attitude of low expectations or resigned humility is almost extreme.

It reflects the opinion that you cannot ask for public health care to deliver consistent quality: access might be good, but then outcomes are lousy or the other way around. Few Western Europeans would accept that.

They know that a well-performing system can deliver on many fronts at the same time.

This narrow Canadian perspective reveals a deep misunderstanding about the impact of the system’s poor overall performance.

Long waiting means those in need of treatment spend years on sick-leave, with pain, anxiety and loss of income. Lack of information on available care providers denies consumers any choice and, without the right to a second opinion, patients are in a weak position in relation to doctors.

Low performing health care does not have to kill you, but it risks causing you a lot of trouble and reduces your quality of life.

However, there are promising signs of emerging consumer progress.

Quebecers are already taking legal steps to introduce more European-style health-care pluralism. Legal cases are also underway in Ontario and Alberta.

A growing number of elected representatives in the provinces oppose the current under-performance in health care.

Leading Canadian reformers, such as doctors Brian Day and Jacques Chaoulli are advancing the discussion for constructive reform.

And if numerous radio talk-show hosts around Canada reflect the warm public response to our consumer index, there is a growing readiness for steps towards meaningful change:

Why not copy the most successful European health-care systems (such as those in Austria, France and the Netherlands) by introducing a mix of purchasers and providers, within the universally accessible health-care system?

Why not get rid of so-called global budgeting and reimburse hospitals for the care they actually deliver, which would increase productivity and reduce waiting? Why not improve access to medicines by following European Union standards?

The Health Consumer Powerhouse and Frontier Centre for Public Policy hope to follow up with another index in June, which will rank the 10 provinces.

This will provide a more in-depth study and give support to policy-makers and health-care consumers to take action. The Canadian health care debate will inevitably change.

Or to put the critical question, as posed by a talk-show host: “Why on Earth are Canadians satisfied with paying zillions for the kind of poor health care performance that people in Rumania are fighting to get rid of?”