This report presents the results of the fourth annual Canada Health Consumer Index (CHCI). The purpose of the CHCI is to provide a comparative evaluation of healthcare-system performance in the ten Canadian provinces from the perspective of the consumer. The CHCI seeks to measure the consumer-friendliness of each province’s 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 Access to Information and Information Technology Development, Primary Care and Problem Prevention, Wait Times, Patient Outcomes and Range and Reach of Services and access to new medicines. For each category, a number of indicators are examined to determine the extent to which each province’s healthcare system is achieving results that benefit the consumer.
The CHCI places a particularly strong emphasis on two specific dimensions of consumer-friendliness: patient wait times and patient outcomes. We seek to help citizens and patients better understand the extent to which their province is delivering timely, effective care in comparison to other Canadian jurisdictions.
In this year’s report, three provinces—Ontario, New Brunswick and British Columbia—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.
In addition to the CHCI, the Frontier Centre produces an international healthcare comparison —the Euro-Canada Health Consumer Index (ECHCI). Our international comparison has repeatedly shown that Canadian healthcare lags well behind the top European systems in terms of responsiveness to the needs of consumers. We advise readers to consider the inter-provincial comparisons presented in the CHCI in this context. Our research suggests 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. This is particularly true in the area of wait times.
Each year, to help better understand the relationship between healthcare spending and healthcare performance, we perform a simple regression analysis to compare overall CHCI scores to per-capita spending levels. For the fourth consecutive year, our analysis shows no positive correlation between higher per capita healthcare spending and higher CHCI scores. 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 that the problems facing 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. The following reforms are discussed in the final section of this report: Continue to transition away from global budgets towards patient-based funding models; and, Co-operate with other jurisdictions in the approval of new medicines to speed up the approval process.
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.
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