Look­ing beyond Canada’s bor­ders for health-care cures

Waterloo Region Record - - EDITORIALS & COMMENT - Bac­chus Barua Bac­chus Barua is as­so­ci­ate di­rec­tor of the Fraser In­sti­tute’s Cen­tre for Health Pol­icy Stud­ies. Dis­trib­uted by Troy Me­dia

As pa­tients, care­givers and tax­pay­ers, all Cana­di­ans care deeply about our health­care sys­tem. It’s im­por­tant to us that the sys­tem has the nec­es­sary re­sources, is ac­ces­si­ble, and de­liv­ers high­qual­ity treat­ment at an af­ford­able and sus­tain­able cost.

Un­for­tu­nately, it’s in­creas­ingly clear that we have a high-cost sys­tem that de­liv­ers me­diocre, and some­times re­mark­ably poor, per­for­mance.

That’s es­pe­cially true com­pared to other coun­tries that share the same goal of uni­ver­sal ac­cess, re­gard­less of abil­ity to pay.

Gone are the days when such un­der­per­for­mance could be swept un­der the rug and the Amer­i­can health-care sys­tem could be dan­gled as the only al­ter­na­tive — the boogey­man scar­ing us into be­liev­ing that the sta­tus quo was nec­es­sary to pre­serve the uni­ver­sal na­ture of Cana­dian health care. Rather, we’re now far more aware that Canada’s is but one way of do­ing uni­ver­sal health care. And the dire con­se­quences of our pol­icy choices are in­creas­ingly ob­vi­ous.

The Fraser In­sti­tute’s jus­tre­leased an­nual checkup com­pares Canada’s health-care spend­ing and per­for­mance to 28 other uni­ver­sal health-care sys­tems on an age-ad­justed ba­sis.

We rank among the high­est spenders — third as a per­cent­age of our econ­omy and 11th on a per­per­son ba­sis.

How­ever, we have re­mark­ably few med­i­cal re­sources to show for that spend­ing.

We rank near the bot­tom for the num­ber of physi­cians avail­able (25th out of 29), and dead last for acute-care beds. It’s no won­der we hear so many sto­ries about fam­i­lies in need of physi­cians, long wait times for treat­ment and over­crowded hospi­tals.

In fact, Cana­di­ans have come a long way to­ward un­der­stand­ing the de­te­ri­o­rat­ing state of wait times in our coun­try. For ex­am­ple, while some may quib­ble over method­olog­i­cal dif­fer­ences, most ac­cept the over­all con­clu­sions of the Fraser In­sti­tute’s an­nual sur­vey: that pa­tients in Canada are wait­ing longer than ever and that physi­cians con­sider such wait times longer than med­i­cally rea­son­able.

Data from other or­ga­ni­za­tions such as the Com­mon­wealth Fund defuse the no­tion that such wait times are a nat­u­ral con­se­quence of uni­ver­sal health care.

For ex­am­ple, 30 per cent of Cana­dian pa­tients re­ported wait­ing for two months or longer for an ap­point­ment with a spe­cial­ist, com­pared with only three per cent in Ger­many, four per cent in France and seven per cent in the Nether­lands. Sim­i­larly, 18 per cent of pa­tients in Canada re­ported wait­ing four months or longer for elec­tive surgery com­pared to zero pa­tients in top-per­form­ing Ger­many.

To be fair, there are some ar­eas where we do rea­son­ably well.

For ex­am­ple, our sys­tem de­liv­ers more con­sul­ta­tions with fam­ily doc­tors, cataract surg­eries and knee re­place­ments than the av­er­age uni­ver­sal health-care sys­tem. We also have fewer pa­tients dy­ing af­ter a heart at­tack, and a stel­lar record on breast and col­orec­tal cancer sur­vival.

On the flip side, we have higher than usual mor­tal­ity af­ter is­chemic strokes, av­er­age sur­vival rates for cer­vi­cal cancer, and the worst record for ob­stet­ric trauma (in­jury to the mother while giv­ing birth).

Canada also re­ports the low­est amount of hospi­tal ac­tiv­ity (as mea­sured by dis­charge rates). On this mea­sure, an op­ti­mistic view would be that our sys­tem is good at keep­ing pa­tients healthy and out of the hospi­tal.

How­ever, a more sober anal­y­sis sug­gests the ex­is­tence of a bot­tle­neck of pa­tients wait­ing to be ad­mit­ted — a view ev­i­denced by the hun­dreds of thou­sands of Cana­di­ans wait­ing for treat­ment.

And there re­mains the ques­tion of why our sys­tem costs so much if it de­liv­ers fewer ex­pen­sive in-hospi­tal treat­ments to pa­tients.

While the tire­less de­fend­ers of the sta­tus quo will un­doubt­edly fo­cus on the few bright spots, the wealth of ev­i­dence sug­gests we have a lot of work to do.

Sim­ply pump­ing more money into an al­ready ex­pen­sive sys­tem is not the an­swer.

Let’s iden­tify coun­tries that do bet­ter than us on the 42 per­for­mance met­rics iden­ti­fied in the Fraser In­sti­tute’s re­port and learn what they do dif­fer­ently so we can im­prove our sys­tem for pa­tients who need it most.

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