Ontario Scores High in Health Delivery Study

Commentary, Frontier Centre, Healthcare, Media Appearances

A new report by the Winnipeg-based Frontier Centre for Public Policy rates Ontario as the top province when it comes to the delivery of healthcare from the point of view of the consumer. At the bottom of the list was Newfoundland.

The Frontier Centre for Public Policy, created in 1997, is an independent think tank. It conducts policy studies on various social and economic issues, including healthcare, education, aboriginals, poverty and housing.

The Frontier Centre for Public Policy produced its first-annual Canada Health Consumer Index in partnership with the Health Consumer Powerhouse (HCP) in Brussels. The Index was written by Rebecca Walberg, the Frontier Centre’s Director of Health Policy, and HCP’s Arne Bjornberg.

(Earlier this year, the Frontier Centre and HCP released the first Euro-Canada Health Consumer Index, which compared the health care systems in Canada and 29 European countries. Canada placed 23rd.)

The Canada Health Consumer Index ranking for the provinces is as follows:

1. Ontario
2. B.C.
3. Nova Scotia
4. New Brunswick
5. Alberta
6. PEI
7. Manitoba
8. Quebec
9. Saskatchewan
10. Newfoundland

The study assessed factors such as: access to primary care, home care and long-term care; wait times for various levels of diagnosis, care and treatment; medical outcomes, infection and mortality rates; ‘generosity’, meaning the range of services covered by the public health systems in the 10 provinces; as well as patient rights and the use of information sources, including the use of electronic health records and easily understood medication formularies.

In the Frontier Centre’s Canadian study, Ontario emerges as the clear winner. A mediocre performance on wait times is more than balanced out by a good showing for outcomes and first-place finishes for patient’ rights, primary care and generosity.

With more attention paid to waiting times, especially for specialist consultations and radiation therapy for cancer, and reduced incidences of nosocomial infection (a problem Ontario hospitals share with Quebec’s), Ontario could lead in all five categories.

While there is room for improvement in all sub-disciplines, it is encouraging that Canada’s most populous province is setting a good example in many respects for the efficient provision of healthcare.

British Columbia and Nova Scotia are both noticeably behind Ontario, but they take second and third place in overall rankings. British Columbia’s performance with regard to generosity, waiting times and primary care is average, but a strong culture of patient rights and a tie for first place with Nova Scotia for outcomes lift it to second place. Nova Scotia’s scores are more erratic. Ranked last for patient rights and second last for primary care, Nova Scotia is second best for generosity and waiting times and shares first place for outcomes.

New Brunswick and Alberta round out the top half for overall performance. New Brunswick ties for second best in terms of providing primary care and otherwise is consistently in the middle of the pack. Alberta has an above average score for outcomes, but the second-worst score for waiting times; this is not unexpected in a province whose population has grown more quickly than its healthcare infrastructure and personnel levels have.

The other three sub-disciplines show Alberta to be approximately average. Prince Edward Island gains its sixth place finish on the strength of second best scores for outcomes and waiting times.

PEI ranks below average on primary care and second from the bottom for patient rights and finishes last for generosity. This score is the lowest by a significant margin. PEI is one of only two provinces that did not score a single green in the generosity sub-discipline, with three reds and only two indicators that rise to a middling score.

While no two provinces have identical scores for overall performance, it must be pointed out that just as Ontario stands a cut above the rest, so do the bottom four provinces function at a separate level from the rest of the country.

They are spread across a range of only 21 points out of a possible 1,000.

While there are differences in how Manitoba, Quebec, Saskatchewan and Newfoundland arrived at their positions at the bottom of the list, small differences in weighting would change this order, and more properly, these four provinces should be understood as contending closely for last place.