Canada spends more on health care than any industrialised nation except Iceland and Switzerland yet ranks near the bottom in terms of access to physicians and new medical technology, according to a new study released today by independent research organisation The Fraser Institute.

"Canada's health care system, in its current format, does not meet the standards set by other industrialised countries, despite being one of the most expensive systems in the world," said Nadeem Esmail, Director of Health System Performance Studies at The Fraser Institute and co-author of the How Good is Canadian Health Care? 2007 Report. "When you look at the results achieved by countries such as Japan or Sweden, both of whom have better results at lower costs, it becomes clear that simply pouring more money into the Canadian system is not the answer.

" The peer-reviewed study, How Good is Canadian Health Care? compares Canada to other OECD (Organisation for Economic Co-operation and Development) countries that guarantee access to health care regardless of ability to pay. Twelve indicators of access to health care and outcomes from the health care process are examined including access to physicians, access to high-tech medical equipment, and key health outcomes. The United States and Mexico are not included in the study because they do not have universal-access systems.

The study focuses on how Canada needs to organise its health care programme to provide universal access to high quality care in a timely fashion. To answer this question, which is also the focus of the current debate about health care reform in Canada, the study examines whether other industrialised countries with universal-access health care have implemented the type of policies that are hotly contested and opposed in Canada, but have been shown to produce superior access to health care and better outcomes at a lower cost.

User Fees and Private Providers

The study found that health care costs can be significantly reduced if consumers of care have to participate in paying for the care they demand through some form of user fees. More than three quarters of the universal-access countries in the OECD charge user fees for access to hospitals, general practitioners, or specialists-in many cases, to all three. Low-income citizens are often exempted from these fees.

"When it comes to banning user fees, Canada is in the minority," Esmail said.Even more surprising, Canada is the only country in the OECD that outlaws privately funded purchases of core services. Every other OECD country has some form of user-pay, private provision of health care. While many OECD countries also rely almost exclusively on public hospitals to provide publicly insured services, more than half of the countries permit private providers to deliver publicly funded care.

"Those who support the status quo and oppose reform here in Canada are behind the times. They don't seem to realise that throughout Europe, Asia and elsewhere in the developed world, nations have built efficient, highly-functioning health care systems by blending public and private health care," Esmail said.

Comparing Health Outcomes

The study finds that Canada, while spending more on health care than any other industrialised country in the OECD except Iceland and Switzerland, ranks 17^th in the percentage of total life expectancy that will be lived in full health; ranks 22^nd in infant mortality, 15^th in perinatal mortality, fourth in mortality amenable to health care, ninth in potential years of life lost to disease, 10^th in the incidence of breast cancer mortality, and second in the incidence of mortality from colorectal cancer.

The Number of Doctors

On an age-adjusted, comparative basis, Canada, relative to comparable countries of the OECD, has a small number of physicians, ranking 24^th out of 28 countries with 2.3 doctors per 1,000 people for a total of 68,171 doctors. To rank as highly as first-ranked Greece , Canada needed 61,679 more doctors than it actually had in 2004. Notably, Canada had the second-highest ratio among 20 OECD countries for which data were available in 1970. Since 1970, however, all but one of these countries have surpassed Canada's growth in doctors per capita. While the age-adjusted proportion of doctors in Canada grew by 24 per cent, the average increase in the proportion of doctors in the other 19 countries was 149 per cent.

It's impossible to determine if Canada has too many or too few doctors in an absolute sense, but we have fewer doctors per capita on an age-adjusted basis than most other countries in the OECD and report longer waits for access to treatment.

Access to Technology

With regard to age-adjusted access to high-tech machinery, Canada performs dismally by comparison with other OECD countries. While ranking number three as a health care spender, Canada ranks 13^th of 24 in access to MRIs, 18^th of 24 in access to CT scanners, seventh of 17 in access to mammographs, and ties with two other nations at 17^th of 20 in access to lithotriptors. Lack of access to machines also means longer waiting times for diagnostic assessment, and mirrors the longer waiting times for access to specialists and to treatment found in the comparative studies examined for this study.

"The evidence is overwhelming; the Canadian health care model is inferior to those used in other OECD countries. The models that work best have user fees; alternative, comprehensive, privately funded care; and private hospitals that compete for patient demand," Esmail said."None of these reforms mean the Americanisation of Canadian health care. The choice is between what we have now and finding a better way to deliver universal access to health care. It's about emulating the successful models in European and Asian countries that do a better job than Canada's at delivering on the promise of universal access to high quality care in a timely fashion regardless of ability to pay."  

Publication and its availability

How good is Canadian Health Care? 2007 report  is available as a download at http://www.fraserinstitute.org/commerce.web/publication

_details.aspx?pubID=5035

Authors: Nadeem Esmail and Michael Walker

Pages: 105

Contents: The study compares Canada’s universal access, publicly funded, health care system to that of other OECD countries with similar systems, which means that the USA and Mexico are not included in the comparisons.