Frontiers Project

Examines successful models of healthcare delivery in other countries that could restore and improve the quality and effectiveness of our own system.  In partnership with a Swedish think tank, we have produced healthcare consumer indexes comparing Canada to 32 European countries, and provincial health systems on patient responsiveness.

Canada's healthcare system is under increasing strain. It faces recurring crises in its present form, despite the continuous allocation of more tax resources.

The decision to structure our healthcare system as a monopoly has had effects that are both far-reaching and little understood. Because funding arrives whether or not they provide good service, health-care workers have no direct incentive to go “above and beyond” or to innovate to provide better service.

Canadians clearly want guaranteed, universal access to medical services. New healthcare models have the potential to retain universality, restore service levels, and control costs while introducing transparency and accountability to the system.


This report presents the results of the fourth annual Canada Health Consumer Index (CHCI). The purpose of the CHCI is to provide a comparative evaluation of healthcare-system performance in the ten Canadian provinces from the perspective of the consumer. The CHCI seeks to measure the consumer-friendliness of each province’s healthcare system—that is to say the extent to which it meets the needs and demands of the people who rely on it.

The CHCI evaluates the consumer-friendliness of each provincial healthcare system across five dimensions—Patient Access to Information and Information Technology Development, Primary Care...


Revitalizing Manitoba:  The Challenge

Manitoba society has many strengths. These include its friendliness and embrace of multiculturalism. But we are not yet living up to our potential.

Compared to most provinces:

• Incomes are low, but taxes are high.

• The provincial debt is already high, and getting worse.

• Our healthcare system is costly, but often performs poorly.

• Infrastructure is crumbling, and we lack the resources to fix it.

• There is a high rate of serious crime.

• Parts...

 Originally appeared in C2C Journal, Canada’s Journal of Ideas (

 Limited Government, quois?

As Friedrich Hayek says in The Constitution of Liberty “If we are to succeed… we must first of all know what we believe.” We must therefore define limited government prior to discussing whether the Saskatchewan Party government has successfully promoted limited government.
Hayek also argues that the ultimate aim of good policy should be liberty, and that means giving citizens the ability to plan future activities without concern of being made a “bare tool in the hands of...

Executive Summary

This report presents the results of the third annual Canada Health Consumer Index (CHCI). This year’s study once again demonstrates that there are meaningful differences between the 10 provincial healthcare systems in terms of their success at delivering timely, consumer friendly care.
As the international Euro-Canada Health Consumer Index (ECHCI) demonstrated again in 2010, Canadian healthcare still lags well behind the top European healthcare systems in terms of responsiveness to the needs of consumers. The top-scoring provinces in this year’s CHCI should be recognized for their relatively strong healthcare-system performance...


This is the third annual Euro-Canada Health Consumer Index (ECHCI). The ECHCI is an international comparison of healthcare system performance in 34 countries. All 27 European Union member states are examined, along with Norway, Switzerland, Croatia, FYR Macedonia, Iceland, Albania and Canada. For the third straight year, the Netherlands finishes in first place in the ECHCI, earning 857 out of 1,000 possible points.
There are several factors that enable the Dutch healthcare system to score highly each year in the ECHCI. Perhaps most importantly, the Netherlands is characterized by competition between many...


In a recent position statement, the Canadian Society of Obstetricians and Gynecologists argued that immigrant patients’ expressed wishes to be treated by a doctor of their own sex, race, culture or religion — reportedly a common phenomenon — should not be reflected in our country’s health-care policy. These professionals feel services should be provided by the most qualified personnel available, period.

As Tom Blackwell reported in the National Post this week, some doctors disagree with this attitude, which they regard as excessively rigid. Dr. Kevin Pottie, an Ottawa doctor who helped to draft the Canadian Guidelines on Immigrant Health, for...

The recent federal government decision to provide health care transfers to the provinces without conditions or demands has prompted a flurry of opinions concerning health care delivery. Some of the issues under discussion are waiting lists and emergency room challenges.

Unfortunately, much of the public discourse about health care has focused on addressing specific issues piecemeal, rather than the need for major policy reform. The system itself is the problem, and we would be wise to address the underlying problems at the heart of Canadian health care rather than simply trying to deal with the symptoms....

“Access to a waiting list is not access to health care.” These words, from the Supreme Court of Canada decision in Chaoulli v. Quebec, apply very personally to Richard Cross and Darcy Allen, who have launched court challenges to the Alberta government’s monopoly over health care.

Dr. Allen was forced to stop practising dentistry due to debilitating back pain. What began in 2007 as a seemingly minor hockey injury gradually turned his life into a nightmare of around-the-clock pain. Normal tasks, like shovelling snow or tying shoelaces, became impossible. On one occasion, Dr. Allen watched


Chongqing, China, has a population of 30 million – almost as big as Canada’s - and is the biggest mega city on the planet. New factories are springing up daily. Entrepreneurship is evident everywhere.

Bangalore, India, is huge also and populated by world leaders in IT, aerospace and industrial research. Its business leaders are writing many of the rules of a new industrial revolution.

The extraordinary performances of these cities and others like them have lifted hundreds of millions of people out of poverty. 

The global impact of this is startling. China and India are on...


As Manitobans brace for an election, they should realize we desperately need a different model, one that is far less political and dependent on government spending.

Since 1999, our NDP government has been on a happy spending spree. Provincial spending per person has increased 65% from $6,379 in 1999 to $10,535 in 2010, or 2.75 times faster than the inflation rate.

How was this spending explosion possible? First, the NDP lucked out with a dramatic expansion in federal transfer payments. In 1999, the feds paid 32% of Manitoba’s bills. Last year, transfers had ballooned...


Winnipeg / Toronto: The Frontier Centre for Public Policy today released the fourth annual Canada Health Consumer Index (CHCI). The index ranks health care system performance from the perspective of the consumer in each province by assessing the extent to which they are meeting the needs of health care users. 

The CHCI compares the ten provincial health care systems across five dimensions of quality. The dimensions of quality examined by the CHCI are:


  • Patient Access to Information and IT Development;
  • Primary Care and Problem Prevention;
  • Wait Times;
  • Patient Outcomes;
  • Range and
  • ...


Regina: The Frontier Centre for Public Policy and the Belgian-based Health Consumer Powerhouse today released the 3rd annual Euro-Canada Health Consumer Index (ECHCI). The Index evaluates the consumer-friendliness of Canada’s healthcare system. It compares Canada to 33 European countries by assessing the extent to which each national healthcare system meets the needs of healthcare users.
In the study, analysts from the Frontier Centre and the Health Consumer Powerhouse compare the 34 national healthcare systems across five different “sub-disciplines:” Patient Rights and Access to Information, Wait Times, Patient Outcomes, Range and Reach of Services and Access to Pharmaceuticals.
The report...



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...

The Frontier Centre for Public Policy, along with its European partner, the Health Consumer Powerhouse today released their annual comparison of health care in Europe and Canada. The Euro-Canada Health Consumer Index 2009 was compiled and authored by Dr. Arne Björnberg and Daniel Eriksson; it measures how friendly a nation's health care system is for those who must consume it, i.e., the patients.

The Index measures patient rights and information, waiting times for treatment, outcomes, the range and reach of services provided, and access to pharmaceuticals.

Measured out of 1,000 points in total, the second annual Euro-Canada Health...

Ontario came in first in the Frontier Centre for Public Policy’s first annual Canada Health Consumer Index which was released today. The Index - published by the Frontier Centre for Public Policy together with its European partner the Health Consumer Powerhouse (HCP) in Brussels - examines healthcare from the perspective of the consumer at the provincial level.

The Index was written by Rebecca Walberg, the Frontier Centre's Director of Health Policy, and HCP's Arne Bjornberg. Earlier this year, the Frontier Centre and HCP released the first Euro-Canada Health Consumer Index, which compared the health care systems in Canada and 29...


Innovation in health care is coming from an unlikely place.

A First Nation in British Columbia is using its unique constitutional position to create what is taboo in the rest of Canada.

The self-governing Westbank First Nation is set to build a 100-bed hospital to serve medical tourists and the wealthy.

According to this piece in the National Post, the Canada Health Act prohibits provinces from charging for medical services by threatening federal transfer payments. However, because reserve lands are within federal jurisdiction, that cannot be done in this case. There is also no penalty mechanism in place to...

A Lancet study finds e-cigarettes appear to cut consumption of smokers.

After six months, however, the 57% of e-cigarette users had halved the number of cigarettes smoked each day compared with 41% in those using patches.

I find it strange that some people want to ban the use of e-cigs in public.  Do they also object to the use of a patch, gum or other delivery devices?

Perhaps it is time to look at e-cigarettes as playing a role in harm reduction.

“We have to logically look at these things,” said Sweanor, who does not accept funds from


In their dealings with teachers and doctors, the Alberta government of Alison Redford is showing preference to one group and derision to another.  But before we get into the arguments, let me state two things right off the bat: I have nothing against paying people well for work done well, and in my preferred world doctors and teachers would not be forced into state employment any more than lawyers and welders as a labour class would be.

All 40,000-plus Alberta teachers received a sweet deal in 2007 when then Tory Premier Ed Stelmach had his eyes on a soon-to-come election...

I once heard a wise man say that governments are always wrong when making economic predictions.  The questions to consider are by how much, and in what direction?

That the Government of Alberta was wrong in its economic predictions should therefore not be big news.  But they were wrong by lots and widely in the wrong direction.  Alberta was predicting averages around $99 a barrel for the past year.  But it was not that prediction that got them in trouble, now facing a likely deficit near the $6 billion mark.

It appears to be the failure to account for the...


SAINT GORAN’S hospital is one of the glories of the Swedish welfare state. It is also a laboratory for applying business principles to the public sector. The hospital is run by a private company, Capio, which in turn is run by a consortium of private-equity funds, including Nordic Capital and Apax Partners. The doctors and nurses are Capio employees, answerable to a boss and a board. Doctors talk enthusiastically about “the Toyota model of production” and “harnessing innovation” to cut costs.

Welcome to health care in post-ideological Sweden. From the patient’s point of view, St Goran’s is no...

In her "A GP for Me" plan, Health Minister Margaret MacDiarmid is promising an extra $100 million for 176,000 new patients. That works out to $568 per year per new patient, which would pay for a simple GP office visit about every three weeks for an average patient, one per month for the frail, or one visit every six weeks for complex or pregnant patients.

Especially for the frail and complex, it is unlikely that my general-practitioner colleagues can provide the medical care needed in the time made available to them per patient by these fees.


Canadian Union of Public Employees (CUPE) President Paul Moist, responding to my August 13 column focusing on government orders to shut down Dr. Brian Day's Vancouver medical clinics, wrote "Simply repeating irrational arguments is no relief for Canadians on waiting lists for health care". Moist must have accidentally overlooked the story in my column about 36 year old Mandy Martens, one of many who received a lifesaving cancer diagnosis at Dr. Day's clinic after facing lengthy waits in the public system. Apparently her story is "irrational "and of "no relief".

A common tactic of those unable to refute...

Amid the hubbub following the release of the Drummond Report, I can’t help but think of one of the biggest financial scams of the past century: Bernie Madoff ’s Ponzi scheme, which wiped out hundreds of formerly well-heeled investors. The lesson from Bernie? If something seems too good to be true then it probably is. Which is exactly what Don Drummond is telling us. For years we’ve been paying taxes to prop up a mismanaged health-care system in the expectation that it will be there when we need it. Now, Don Drummond is telling us the Ponzi scheme is...

Patients in Ontario now have better access to a physician, they are receiving more services and the quality of care being delivered has improved according to a new report released by the Ontario Medical Association on primary care. The same report also notes that changes to primary care have led to a reduction in non urgent visits to the emergency room.

The report, "Primary Care in Ontario: Reforms, Investments and Achievements", illustrates that having access to a family doctor decreases the number of emergency room visits for minor conditions. For example, the number of semi-urgent and non-urgent visits...