Expensive System, Mediocre Outcome

Commentary, Healthcare & Welfare, Wayne Anderson

It often seems as though it is impossible to have a non-emotional discussion about health care because the issues are frequently distorted for political reasons.

So what is the state of health-care delivery in Canada and Manitoba compared with other industrialized nations? Does it deserve to be treated as a sacred cow that cannot be changed in any way? It seems most Canadians believe it is excellent, even though they may have waited months for elective but necessary procedures.

Is it truly excellent? It certainly is expensive. Does it provide quality patient outcomes for the tax dollar spent? There has been a lot of research done comparing the health-care systems of the 34 industrialized countries of the Organization For Economic Co-operation and Development. Any meaningful comparisons need to examine both expenditures on health care and patient outcomes.

So we start with how expenditures in Canada and Manitoba compared with those OECD countries that provide universal access to health care. These comparisons can be readily drawn from the OECD health-care data. Among the OECD countries that provide universal access, Canadian taxpayers spend 10.9 per cent of GDP compared with the average of 9.3 per cent, so we spend 17 per cent higher than the OECD average. Germany is the highest at 11.8 per cent of GDP.

A comparison of per capita expenditures yields similar results. Canada spends US$4,602 per capita compared with an OECD average of US$3,484, so we spend 32 per cent more on health care per capita than the average of those OECD countries offering universal access to health care. Canadian taxpayer spending on health care is among the very highest of all industrialized nations.

Given that our health-care expenditures are among the highest in the world, how do our patient outcomes compare? We are paying for a world-class health-care system, but are we getting world-class results? Let’s look again at how our metrics stack up when compared with the OECD. The Commonwealth Fund, in 2013, compared wait times in 11 OECD countries, essentially the top spenders, and Canada was the worst performer.

The health-care performance data compiled by the OECD over the last three to four years shows Canada was 26th in access to physicians, 16th in access to nurses, 24th in hospital beds and on and on it goes. These data confirm that while Canadian taxpayers are among the very highest spenders on health-care delivery, our performance is below the OECD average and substantially below those countries spending comparable amounts. In 2010, the Euro-Canada health index ranked Canada’s performance 25th compared with the 34 European countries analyzed.

What about Manitoba. How do we measure up compared with other provinces? Well, once again, Manitoba, which spends approximately 44 per cent of its annual budget on health care and on a per capita basis has the second-highest spending of all the provinces, does not produce results commensurate with our level of spending. Our results are worse than average.

For example Manitoba’s wait times for patients seeking medical treatment in 2013 was 20.3 weeks compared with the national average of 18.2. Manitoba’s emergency room wait times were 5.6 hours compared to a national average of 3.2 hours.

These statistical comparisons confirm that while Canada has one of the most expensive health-care delivery systems, it produces very mediocre patient outcomes. On a value-for-money basis, we lag the best performers significantly. Similarly, Manitoba’s health-care delivery is more expensive than the Canadian average and our patient outcomes are below average.

So having established Canadians and Manitobans spend a lot on health-care delivery, but receive mediocre patient outcomes at best, how can it be improved? We believe there are many areas that can be improved. In future articles, we will offer some ideas for reform, focusing on the areas where we have some experience and expertise.

Originally published in the Winnipeg Free Press, March 28, 2016

Wayne Anderson is chair of the Frontier Centre for Public Policy.  He is past chairman of the board of St. Boniface General Hospital. He wrote this in co-operation with Dal McCloy, past chairman of Riverview Health Centre, and Judith Scanlan, R.N., PhD, past secretary of St. Boniface hospital’s board.