This report presents the results of the third annual Canada Health Consumer Index (CHCI). This year’s study once again demonstrates that there are meaningful differences between the 10 provincial healthcare systems in terms of their success at delivering timely, consumer friendly care.
As the international Euro-Canada Health Consumer Index (ECHCI) demonstrated again in 2010, Canadian healthcare still lags well behind the top European healthcare systems in terms of responsiveness to the needs of consumers. The top-scoring provinces in this year’s CHCI should be recognized for their relatively strong healthcare-system performance in comparison with other Canadian jurisdictions. However, readers of this report should recognize that even top-performing Canadian provinces still have much work to do in order to reach the level of excellence that exists in European countries such as the Netherlands, France and Germany.
The purpose of the CHCI and its sister project, the ECHCI is to provide an evaluation of healthcare- system performance from the perspective of the consumer. In many areas of public policy, healthcare included, performance evaluation is often based on the measurement of inputs and certain types of easily measurable outputs that do not necessarily reflect the effectiveness of the relevant program or policy. Counting resource inputs such as hospital beds and doctors per capita does not tell us very much about the care that consumers actually receive. The amount of time the average person has to wait for an MRI is a much better indicator of healthcare quality than is the number of MRI machines in a particular country.
Instead of measuring inputs, such as spending levels and resources used, this index attempts to measure outcomes from the perspective of the consumer. The CHCI seeks to measure the consumer-friendliness of each national healthcare system—that is to say the extent to which it meets the needs and demands of the people who rely on it.
The CHCI evaluates the consumer-friendliness of each provincial healthcare system across five dimensions—Patient Rights and Access to Information, Primary Care and Problem Prevention, Wait Times, Patient Outcomes and Range and Reach of Services Provided. For each of these categories, a number of indicators are examined to determine the extent to which each province’s healthcare system is achieving results that benefit the consumer.
In this year’s report, the top three provinces— Ontario, British Columbia and New Brunswick— finish in a distinct top tier in the overall rankings, well ahead of the remaining provinces. The high scores for these provinces are largely the result of wait times that are shorter than the Canadian average in important areas and patient outcomes that are similar or superior to national standards. However, our research suggests that in a number of areas—particularly wait times—even these top-performing Canadian jurisdictions currently lag behind leading European jurisdictions. The high scores earned by these three provinces should be interpreted as evidence of relative consumer-friendliness within the Canadian context, but they should not distract from the fact that much work is needed across the country to meet the levels of consumer-friendliness and timeliness of care that are taken for granted in much of Europe.
The remaining provinces fall into a distinct second tier well behind the top performers. All seven of the remaining provinces fall within a relatively narrow 51 point range, between 610 and 661 points in our overall rankings. Each of these jurisdictions has one or more areas of weakness that contributed to its ranking in the second tier.
The strengths and weaknesses of each province are discussed in detail in the body of this report. While this report details meaningful differences between the seven provinces in the second-tier in specific areas, it is important to stress that the overall scores achieved by these provinces are very close to one another by the historical standards of the CHCI and when compared to the gap between all of these provinces and the three top performers. We caution readers to be careful not to attribute undue importance to small differences between provinces in individual categories or even in overall scores. It is particularly important to stress this fact for this year’s index, since so many of the provinces were clustered very close together in the overall rankings.
While the existence of a five-point gap between Alberta and Saskatchewan should not be taken as evidence that Saskatchewan’s healthcare system is substantially more consumer-friendly than its neighbour’s, the 100-point gap between these provinces and British Columbia or Ontario can confidently be interpreted as evidence of a meaningful disparity in terms of overall consumer-friendliness.
Saskatchewan is one jurisdiction whose results merit special attention. Saskatchewan finishes in the second tier, it has improved significantly since last year when the province finished in last place. This advance is the result of a relative improvement in wait times for several key indicators. Wait times for knee-replacement surgery and cancer radiation therapy are two important indicators in which Saskatchewan showed improved performance.
Alberta is another province of particular interest, as it has fallen in the rankings due to increases in wait times. Long waits for cancer radiation therapy, cataract surgery and appointments with specialists following a referral drove down Alberta’s score. The province’s strong performance in the important patient outcomes category prevented the province from falling out of the second tier. However, Alberta’s generally long wait times negatively affected its overall score and prevented Alberta from challenging the top-performing provinces. Alberta finishes in a tie for seventh place in the rankings, bunched closely with several other provinces, but ahead of only PEI and Newfoundland. Alberta’s long wait times are particularly troubling considering that the province’s per capita spending on healthcare is among the highest in the country.
Alberta’s high spending and middling performance reflects a general trend that has emerged in our analysis of the CHCI over the past several years. Historically (including this year), our analysis has not shown a relationship between per capita healthcare spending and the level of consumer-friendliness achieved in the provinces.
This should be taken as evidence that the poor results shown by low-performing provinces are not caused by a low level of healthcare spending, and the problems that exist in these jurisdictions likely cannot be solved simply by throwing money at them.
Clearly, solutions other than simply increasing spending are needed to improve healthcare system performance. This report describes a few reforms that could improve healthcare performance across the country. The following reforms are discussed in this report:
• Move away from global budgets to patientbased funding models
• Co-operate with other jurisdictions in the approval of new medicines
• Introduce means-tested co-payments
Governments across Canada should ensure that their citizens consistently have timely access to excellent healthcare services. All 10 provinces currently fall short of this goal, and we hope this year’s CHCI will help policy-makers and citizens in each province identify areas where there is a need for aggressive reform.
View entire study as PDF (38 pages)