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.

3 comments:

  1. Thanks, Ahmed
    Amen on the information systems and universal pharmacare.

    As near as I can work out parallel private care not only takes resources away from public care, but gives some governments and some people the idea that they forget about the gaps in public service.
    Janet

    I am concerned that the narrow view many of our planners and politicians take of waiting lists and other services target a few high profile needs/services and then re-arrange the deck chairs to meet the high profile needs, and actually reduce services in some other areas. Any ideas how to address that?

    ReplyDelete
  2. Thanks for the post! This is a great question. Too often we focus on wait times as our major issue and quickly the conversation switches to how a parallel private system is the answer. I think this report brings forward exactly where we lag behind which is helpful. It's also helpful to know that other countries are doing more with less money. The question is how!

    The fact that other countries do much better than us on EQUITY of dental treatment shows that we should consider whether dental SHOULD be part of medicare. (there is in fact research being done right now to suggest that dental disease during pregnancy can lead to increased preterm labour).

    Computerization is another interesting point - I'd be curious to know whether most European countries have individual privately purchased EMR systems in various doctors' clinics like we're starting to have or whether they invested in one system overall that was commissioned by the govt.

    Finally, it's important to realize that European nations tend to have MORE health services in the public sector (drugs, dental) than Canada, as well as have BETTER social security systems. This suggests that an expansion of a public system is more likely to lead to less costs (as % GDP) and increased equity overall.

    ReplyDelete
  3. Amen on the information systems and universal pharmacare.

    As near as I can work out parallel private care not only takes resources away from public care, but gives some governments and some people the idea that they forget about the gaps in public service.
    Janet

    I am concerned that the narrow view many of our planners and politicians take of waiting lists and other services target a few high profile needs/services and then re-arrange the deck chairs to meet the high profile needs, and actually reduce services in some other areas. Any ideas how to address that?

    ReplyDelete