Ranking Canada's health care systems

Rebecca Walberg Back in January the Frontier Centre for Public Policy (FCPP) and Europe’s Health Consumer Powerhouse (HCP) released the first annual Euro Canada Health Consumer Index, comparing the user-friendliness of Canada’s healthcare system with those of 29 European countries.

The results were startling, especially for Canadians who have been led to believe that our health care system is the best in the world. Canada ranked 23^rd out of 30, only outperforming a handful of eastern European states with developing economies, such as Slovakia, Romania, Lithuania, Poland, Bulgaria and Latvia.

The question remained, however, as to how each of our provinces’ health care systems stacks up when compare to each other.

This week, the HCP and FCPP released its Canada Health Consumer Index, focusing on each provincial healthcare system. The report yielded insight into the state of health care in Canada, highlighting the extensive differences consumers encounter from province to province.

In our study, Ontario emerges as the clear winner, leading the provinces by a large margin in the successful provision of primary care, and placing first with regard to the level of service provided. Medical outcomes in Ontario are also above average and, while there is room for improvement particularly in reducing waiting times, Ontario is home to the best healthcare in Canada from the perspective of the consumer.

British Columbia and Nova Scotia place second and third respectively, with only a slim margin separating them. British Columbia tied for first place with Nova Scotia in the ranking of medical outcomes - the most important set of indicators - and tied for second in the establishment of a climate respectful of patients’ rights. Nova Scotia owes its strong finish to excellent outcomes and also to the generosity of its healthcare offering, second only to Ontario.

Clustered at the bottom of the Index are Newfoundland at tenth place, followed by Saskatchewan, Quebec and Manitoba. Just as the top performers arrived at their scores by different means, so do these four provinces have their own weaknesses, as well as some strengths.

While showing promise in the area of patient rights, Newfoundland has a dismal record of medical outcomes, and provides relatively little healthcare to its residents when compared with the rest of the country. On the other hand, Saskatchewan, while deploying new pharmaceuticals very effectively, has serious problems in the provision of primary care, waiting times, and overall generosity. Quebec has the worst score for outcomes and primary care in the country, but has the best performance in Canada for waiting times. Manitoba performs well at the level of primary care, but places tenth for waiting times, and lags badly in the efficient use of drugs.

While no two provinces provide healthcare in an identical manner, there are a number of trends that hold true of the country in general. It must be noted that even the best performing provinces have imperfect systems, and no province has a perfect score in any area of the Index. In terms of waiting times and overall generosity, the top-ranked provinces fare well only compared to their fellow provinces; when compared to their counterparts in Europe, all Canadian provinces have unacceptably long delays for diagnosis and treatment, and the great majority impose significant waits and financial barriers to effective use of up-to-date pharmaceuticals.

Examining the performance of each province in light of per capita healthcare spending was also startling. Ontario and BC, the first and second place finisher overall, are ranked first and third respectively in the “Bang for the Buck” calculation, meaning that they achieve their high position without spending significantly more than the average. Quebec, which finishes eighth overall, comes in second in the BFB rankings, delivering mediocre healthcare on a comparatively modest budget. Whether this tradeoff, modest medical care for a modest cost, is a good one is an issue to be decided by Quebec voters.

Alberta, while lying in the middle of the field for overall performance, falls to eighth in terms of value for money, simply because it spends the greatest amount on healthcare per capita but gets relatively little for it. As a percentage of GDP, wealthy Alberta spends fairly little, but in absolute terms the province has the most lavish health budget per capita, with no corresponding increase in quality.

We also found a relationship between spending and waiting times. The three provinces with the worst waiting time scores, Manitoba, Alberta and Saskatchewan, all spend significantly more than the national average, while the three provinces that do the best on waiting times, Quebec, PEI and Nova Scotia, all spend less than the average, significantly less in the case of PEI and Quebec. These results should make it clear that a province’s ability to provide timely consultations, diagnoses and treatments is not dependent upon its ability to spend huge amounts of money on healthcare.

Ever-expanding healthcare budgets that are not accompanied by major structural reforms, it seems, is not the answer. If we are to improve healthcare in general, and cut waiting times in particular, we must look beyond simply the financial.

Keywords: Rebecca Walberg, Frontier Centre for Public Policy, Euro Canada Health Consumer Index, Canada Health Consumer Index, Newfoundland, Saskatchewan, PEI, Ontario, Quebec, Alberta, British Columbia, health care, Manitoba, Nova Scotia

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