Wednesday, July 21, 2010

What Can be Better in Canada’s Health Care System?

The Commonwealth Fund has updated its ranking of health care systems. According to this fund, we have a better health care system than the United States.  We do very well when all determinants of health are considered, coming in second in the “Long, Health, and Productive Lives” category.  But overall, the other advanced market economy countries included in the ranking (Australia, Germany, Netherlands, New Zealand, and the United Kingdom) did better than Canada.  That means we finished 6th of 7, which should cause all of us to pause and think for a moment.

Where can we do better? Canada ranked last in terms of quality of care. While we did pretty well on questions such as whether the doctor asked about emotional problems (3rd place) or whether patients received advice about weight, nutrition, and exercise (2nd place), we were far behind all countries on questions about basic computerization (being able to print out a list of patients, sending reminders, printing out lists of patient medications). Indeed, almost all of the quality of care and efficiency indicators where Canada did badly focus on information systems or coordination of care.

While Canadians pride themselves on prioritizing access to care with Medicare, the Commonwealth Fund report indicates that we did relatively well in minimizing cost-related access issues but lost many marks in terms of timeliness of care.

Finally, Canada gets mid-range marks when it comes to equity measures for health but poor marks, not surprisingly, when it comes to equity in dental care or prescription drugs. Of patients with below-average incomes, one-third did not see a dentist even though they needed one because of the cost and one-fifth skipped doses or did not fill a prescription because of cost.

Of course, there are problems with such rankings. Many of the indicators are based on surveys of patients and physicians, which are prone to reporting biases (both perceptions and willingness to report long waiting times might be influenced by media reports, for example). It’s not always clear that the indicators are equally important. Some of the data is a few years old. And it is not possible using these data to differentiate between provinces to see if province-specific initiatives to reduce waiting times have been effective.

Nevertheless, the results are useful in that they remind us of the importance of constant evaluation and of the importance of international (not only U.S.) comparisons. The results are also instructive and clearly point to areas that others have identified as needing improvement – coordination of care and better communication, basic information systems, continued attention to waiting lists, public dental care, and universal pharmacare. Notably, none of these indicators would improve by establishing a parallel private system.