May 26, 2009
On Healthcare, Former East Bloc Countries Beat Canada's System
The Canadian health care system is opaque, unconcerned with patient satisfaction and, of course, has lengthy waiting times for medical services as a defining feature. Canadians are aware of these problems, but many accept them as the unfortunate but inevitable consequence of universal coverage; that's because they believe our model is better than “the alternative,” a supposedly wholly private American-style system which leaves millions uninsured and without access to quality care.
But the Canada-U.S. comparison is stale. A better one is to compare Canada with Europe. In Europe, universal coverage is achieved through a publicly-funded system but without the inefficiencies and delays which plague Canadian health care.
The gap between the quality of health care enjoyed by most Europeans and that received by Canadians is strikingly large. A recent Frontier Centre study compares Canada to European countries on a wide variety of indicators of health care quality and ranks Canada 23rd out of the 32 nations surveyed.
That Canada’s health care system falls far short of the wealthy countries of Western Europe might come as no surprise. But what is startling is that Canada also ranks below several poorer nations in Eastern and Southern Europe, such as Slovakia and Estonia. Despite levels of per capita health care spending near the top of the pack, Canada shares the bottom tier in the results rankings on health care systems with middle-income nations like Latvia and Romania.
One critical difference between European health care systems and Canada’s is that Europeans do not endure the stressful and often painful waiting periods with which Canadian patients are all too familiar.
For example, when sick, consider the reasonable desire of patients to see their family doctor as soon as possible. When asked how quickly they received an appointment with their family doctor the last time they requested care, just 22 per cent of Canadians report receiving an appointment on that same day. What’s more, 30 per cent endured a lengthy wait of more than six days before they could see a physician. By comparison, in the United Kingdom, 41 per cent of respondents received an appointment on the same day they requested care and only 12 per cent were forced to wait for more than six days.
Or another example. The typical waiting period for an MRI examination in Canada is over two months; in Ontario, the median wait time is two-and-a-half months. In the high-performing European health care systems, the waiting period for an MRI exam is generally less than three weeks; in Switzerland, the waiting period is routinely less than seven days.
These examples illustrate how many European countries succeed in providing health care coverage to all citizens but yet avoid the delays and inefficiencies endemic in Canada's system.
So how do they do it? European governments embrace delivery models that foster competition between insurers and providers within a universal publicly funded system, and which by their design reward excellence among health care institutions and professionals.
In Sweden, for example, hospitals compete for customers and are paid (by the government) a per-treatment fee for each different service provided. This approach has led to dramatic increases in hospital productivity and efficiency since its introduction in the early 1990s; it's provided a powerful incentive for hospitals to focus on the needs of health-care consumers. Under this model, hospital budgets are determined by productivity and responsiveness to consumer demand and not the confusing and opaque bureaucratic processes that govern hospital budgets in Canada.
By looking to Europe for inspiration on health care, Canada can transform our inefficient and bureaucratic system and yet maintain universal coverage. Canadians have spent enough money for a world-class health system for decades. It’s about time we get what we’ve paid for.
holds a Master of Arts in political studies from the University of Manitoba as well as a Bachelor of Law from the University of East Anglia (United Kingdom). He is fluent in English, French and German and his policy work focuses on European political and economic affairs.