Does Pay More Get, Less Make Sense?


Like Santa Claus and the Easter Bunny, the myth endures that Canada has a system of healthcare services that is among the best in the world. Unlike Santa and Br’er Rabbit however, both as benevolent as it gets, the widespread belief that healthcare in Canada is top drawer is both wrong and an obstacle to making it right. The public complacency it generates is a major obstacle to the transformative changes long known to be essential to enhancing the health of the citizenry at a reasonable and sustainable cost. It doesn’t make sense to spend so much on healthcare that we have to underfund education, financial security, affordable housing, and others of the social determinants of health that collectively determine fully 75% of the health of the population[1]. When it comes right down to optimizing the health of Canadians, healthcare’s repair-shop tail is wagging the dog!

What are the facts about the quality and cost of our so-called “system”?

Among the comparisons of healthcare services that have been done those by the Commonwealth Fund[2] are the most widely available and securely founded on the evidence available. Done first in 2010 comparing seven countries, the 2014 edition includes information from the OECD, WHO, and the Fund’s own surveys of patients and physicians in eleven developed countries. Where does Canada stand overall? We stand tenth – next to the United States in last place! Where did we stand in 2010? Sixth out of seven, a consistent placement but one hardly supportive of the popular myth that our system of healthcare services is among the best.

What countries are being compared and where do they stand in the pecking order? They are the United Kingdom (1st), Switzerland (2nd), Sweden (3rd), Australia (4th), Germany and the Netherlands (tied for 5th), New Zealand and Norway (tied for 7th), France (9th), Canada (10th), and the United States (11th).

The overall ranking is based on six criteria. The first five constitute measures of how good each country’s system is in providing the services the population needs and how good they are. The first criterion is quality of care in which Canada stands 9th (up from last of 7 in 2010), a criterion that is subdivided into four sub-criteria, effectiveness of the care provided (Canada ranks 7th of 11), its safety (10th), how well the various services are coordinated (8th), and how patient-centered they are (8th). The second is access to care in which Canada ranks 9th (previously 5th of 7); against the sub-criterion of accessibility limited by patients’ ability to pay Canada stands 5th and against timeliness of care we rank dead last. Against the criterion of efficiency, we stand 10th; against that of equity 9th; against how healthy people are in Canada relative to the other countries we rank 8th. Neither complacency nor passive acceptance is what you would or should expect most people to exhibit when informed of results like these.

The sixth criterion used by the Commonwealth Fund in its rankings is a financial one, the cost per capita[3] of providing each county’s healthcare services. Here again the United States is an outlier; in 2014 it spent the most money, $8,508 per head. The next highest spenders were Norway ($5,669) Switzerland ($5,643) and the Netherlands ($5,099) The quality of healthcare services leader, the United Kingdom, was also among the leaders in thriftiness, spending $3,405 per capita; New Zealand ($3,182) was not far off. Canada ($4,522) stood at the top of the middle group of Australia ($3,800), Sweden ($3,925), France ($4,118) and Germany ($4,495).

In an earlier study[4] Canada ranked 10th out of 17 countries overall and was judged to be particularly inefficient, spending fully thirty percent more on publicly supported healthcare than would be required to meet the OECD’s benchmark for efficiency.

In 2016 spending on healthcare services in Canada is predicted by CIHI to be $6,299 per capita or 11.1% of GDP; each of us is spending $1,890 directly out of our pockets and purses and $4,409 in the form of taxes. We are spending more money than people do in other developed countries, the United States excepted, for healthcare services that are nowhere near the best. We are not getting our money’s worth. It’s time to make transformative changes to rectify that!

[1] Healthcare services account for about 25%

[2] Davis K., K.Stremikes, C.Schoer, & D. Squires.2014. Mirror, mirror on the wall, 2014 update. How the U.S. health care system compares internationally. The Commonwealth Fund. June, 2014.

[3] measured in purchasing power parity against the US$

[4] The Organization For Economic Co-operation and Development (OECD). 2010. Health care systems: Getting more value for money (OECD Economics Department Policy Notes, No.2)

Authored by members of the Queen’s Health Policy Council:

Don Drummond
Chris Simpson
Duncan G. Sinclair
David Walker
Ruth Wilson

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