December 15, 2009
The second annual Canada Health Consumer Index (CHCI) compares the provinces on health care from the perspective of the consumer;
- Ontario tops the Index: Good patient outcomes and shorter-than-average wait times are the primary reasons; Manitoba, Newfoundland, Saskatchewan and Quebec are grouped together at the bottom;
- No significant relationship is found between spending and performance; some of the biggest health care spenders such as Manitoba finish near the bottom of the index;
- Even the top-performing Canadian jurisdictions deliver services that are often inferior to most European countries; in particular, wait times for health services are much longer across Canada than in Europe.
Media Release - Canada Health Consumer Index 2009
Winnipeg, Brussels and New York: The Frontier Centre for Public Policy and the Brussels-based Health Consumer Powerhouse today released the second annual Canada Health Consumer Index (CHCI). The index ranks health care system performance in each province by assessing the extent to which they meet the needs of health care users.
In the study, analysts from the Frontier Centre and the Health Consumer Powerhouse compare the ten provincial health care systems across five different “sub-disciplines:” patients’ rights, problem prevention, wait times, patient outcome and range and reach of services.
The report shows that there are significant differences between the provinces in several of these areas.
- For the second straight year, Ontario finishes with the highest overall score on the CHCI. Ontario’s high score is driven primarily by good patient outcomes and shorter-than-average wait times. Even in Ontario, however, wait times are much longer than in most of Europe. For example, the average wait time for an MRI in Ontario is approximately 15 weeks, compared to just one-to-three weeks in most of Europe.
- British Columbia, New Brunswick, Alberta and Nova Scotia finish in second through fifth place respectively. Each of these provinces has areas of strength but other areas in which improvement is needed. For example:
o British Columbia’s performance in the “Problem Prevention” category is only middling; B.C. earns 110 out of 150 possible points, compared to the top score of 140 in Ontario.
o Unlike neighbouring Nova Scotia, New Brunswick does not post expected wait times for MRIs and CT scans on its provincial health website;
o In Alberta, wait times for radiation treatment for cancer patients are longer than in most other provinces. Only 70% of cancer radiation therapies begin within the nationally agreed-upon 28 day benchmark. By contrast, 95% of cancer patients in British Columbia commence radiation within 28 days from the decision to treat;
o Long wait-times are a problem for several procedures in Nova Scotia. Only 45% of hip replacement surgeries are performed within the national benchmark of six months. In Quebec and Ontario, 90% of these surgeries are performed within six months of the decision to treat.
- Prince Edward Island finishes in sixth place. PEI is the only province that does not offer 24/7 “tele-health” services to its residents.
- Manitoba, Newfoundland, Saskatchewan and Quebec are clustered near the bottom of the rankings:
o In Manitoba, time-sensitive hip-fracture surgeries are not provided as quickly as they should be. Only 52% of these pain-relieving surgeries are provided within 48 hours. In higher performing provinces, over 65% of these surgeries occur within 48 hours;
o In Newfoundland, the 30-day mortality rate for stroke victims is higher than anywhere else in the country;
o Saskatchewan earns the worst score in Canada in the “Wait Times” sub-discipline. Saskatchewan earns just 143 out of 300 possible points. By comparison, Ontario scores 257 out of 300;
o Quebec’s low score is driven primarily by the province’s inconsistent performance measurement and data collection processes.
The authors of the report did not find a significant relationship between per capita healthcare spending and healthcare performance. Some low-performing provinces such as Manitoba are among the biggest healthcare spenders; some high-performing provinces such as Ontario have relatively low per capita spending.
“Clearly, solutions other than simply increasing spending are needed to improve healthcare-system performance,” writes report author Ben Eisen. “Very often in the evaluation of government programs, the wrong things are measured. Evaluators often incorrectly focus on measuring the inputs to government activities: the number of doctors hired, the number of machines bought, the amount of money spent.”
“These are easy to measure, but they really don’t tell us very much about program performance. Instead, we need to view the evaluation of government performance as an effort to answer a very simple question: are the existing policies and programs meeting the needs of the individuals that they are intended to benefit?”
Recommendations and needed reforms:
o Make healthcare truly portable. Some provinces provide medical services more efficiently than others. Residents of less efficient provinces should be able to travel to provinces where treatment slots are open.
o Enact patients’ rights laws and wait-time guarantees. The Canadian provinces, in co-operation with the federal government, are taking steps in this direction, but they should accelerate the pace with which they are creating guarantees of timely care. Long waits are the biggest single problem in the Canadian healthcare system.
o Move to patient-based funding. Most Canadian hospitals are still funded through the global budgeting model in which hospital revenue is determined by bureaucratic processes not directly linked to the number of patients treated or the quality of hospital outputs. The majority of Organisation for Economic Co-operation and Development (OECD) countries, including many European nations such as Sweden and the Netherlands, have already implemented some form of patient-based funding. This approach has proven capable of dramatically improving healthcare-system efficiency.
Download a copy of the Canada Health Consumer Index 2009 here:
For more information and to arrange an interview with the study's author, media (only) should contact:
204-977-5050 or toll free 877-219-0033 ext. 1
Troy Media Corporation
The Frontier Centre for Public Policy
is an independent public policy think tank whose mission is "to broaden the debate on our future through public policy research and education and to explore positive changes within our public institutions that support economic growth and opportunity."