Other countries do health care better, cheaper
Per- capita health care spending in Canada is 87 per cent higher than Japan’s age- adjusted level, 26 per cent higher than Australia’s, and higher as well than every other developed country with universal care.
“Unfortunately, the performance of Canada’s health care system does not reflect this level of expenditure,” writes Nadeem Esmail, director of health policy for the Fraser Institute. He makes this same understatement word for word in both of the first two series of papers on other countries’ systems, and I expect to see it repeated in four more that are planned for the next several months.
Despite all the yip- yap about Canada’s sacred Medicare trust, our system is neither unique nor particularly good. And it consistently trails most of our peer countries — except the U. S. — when it comes to cost- effectiveness. ( The hybrid American system is the most expensive, per capita, in the world.)
In separate papers — the Australian one out since February, and the one on Japan just released — Esmail compares our system and theirs in several specific areas. He found the Japanese outperform us on three of five measures. We have more doctors and nurses per capita, but they have more MRI machines, CT scanners and hospital beds. He didn’t even look at the most important, bottom- line health outcome — life expectancy — because too many physical and social factors may influence it, but I note the Japanese outlive us by an average of 2.7 years. And he had no data on Japanese waiting times, though they’re generally seen to be reasonably short — certainly shorter than ours.
Canada beat Australia in just one category — the number of MRIs per capita. We trailed in the ratio of doctors, nurses, hospital beds and CT scanners to population, and in waiting times for emergency care, primary care and elective surgery.
So what do these countries know — or do — that we don’t? The main thing both do differently is “activity- based funding” for hospitals — paying for specific procedures performed or services provided.
Both also have some level of costsharing with patients — the Australians for outpatient services only, and the Japanese for everything. And both incorporate some private provision of hospital and surgical services, the Japanese more so than the Australians.
In addition, the Australians allow a broader, private parallel health care sector with taxpayer support than Canada does, and the Japanese have a system of independent insurers that, as a network, covers everybody.
Most of these approaches, Esmail argues, would be allowed under the Canada Health Act ( CHA). But even if some practices would run afoul of this law, “compliance with the CHA neither validates nor invalidates policy reforms.
“It is critical to recognize that many of the health policies pursued throughout the developed world would violate the CHA and past federal interpretations of the CHA. Yet these reforms have been shown to provide superior access to, and outcomes from, the health care process.”
These will no doubt be seen as fighting words by some knee- jerk defenders of the Canadian system, and pretty well anything Esmail says will be dismissed by some because he is from the Fraser Institute, a think- tank well known for its right- of- centre views.
So it is instructive that the preface to this series of studies was written by Janice MacKinnon, now a professor of public health at the University of Saskatchewan, but also a former politician who, as the Saskatchewan NDP’s finance minister, was the first in Canada to balance her budget in the 1990s.
“Looking at other OECD countries for solutions to Canada’s health care challenges will not necessarily lead to a consensus about the changes required,” she wrote. “I myself do not agree with all of the recommendations contained in the studies that follow.
“I do, however, strongly support the need to look beyond North America for solutions and to have an open and vigorous debate about what changes are needed to improve the affordability and effectiveness of Canada’s health care system.”
This is a view that can be shared by thinking Canadians of any political stripe. I look forward to the next four studies in the series, which will look at how citizens get more bang for their health care buck in Sweden, Switzerland, the Netherlands and Germany.