Which province has the best health-care system in Canada?

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It's report card season – and not just for school kids.

The Conference Board of Canada has doled out grades to each of the provinces in a variety of areas and then tallied it up to provide a single mark for overall health performance.

So, how did your province fare?

A grades went to B.C., Alberta and Ontario; B scores were earned by Quebec, New Brunswick and Nova Scotia; D was the mark given to Saskatchewan, Manitoba, Prince Edward Island and Newfoundland and Labrador. (Read the whole chart)

Rankings like this invariably cause a stink. Back in 2000, the World Health Organization tried to determine which country had the best health system in the world and the outcry was such that they never tried again. (The answer, by the way, was France; Canada ranked 35th and the U.S. 38th.)

So far, the response to the Conference Board report card has been subdued. Not surprisingly, the A provinces were bragging and the D provinces were miffed. Most of the quibbling is about methodology.

Trying to judge the quality and effectiveness of a massive health system – Ontario alone spends $47-billion a year to provide publicly funded health insurance to its 13.5 million citizens – is a complex task.

The reality is that every patient has a different and very personal healthcare journey (to use a well-worn cliché) – and most of their experiences are positive by the way.

But the care can always be better, faster, more efficient, and more cost-effective. Too many people fall between the cracks, and there is too much waste. These are not just questions of medical care but of systems engineering and administration.

The health system is not very good at articulating its goals: Even though one in every eight dollars spent in the Canadian economy goes to health spending, medicare does not have a mission statement. However, the idea, presumably, is that universal health care should reduce individual suffering and ultimately result in a healthier population.

There are many other factors other than access to medicine that influence population health, chief among them income, education and housing which, in turn, influence people's lifestyle choices.

You can take issue with the marks assigned by the Conference Board researchers but the organization can't be accused of cutting corners. To get a sense of how well each province's health system was doing overall, they measured 90 different indicators in a variety of categories, including lifestyle factors, health status, health resources and health care system performance.

While the grades are what create the headlines, they are not ultimately what matters. What does matter is that the Conference Board actually tried to do the interprovincial comparisons. They are creating a baseline measurement, and hopefully they will repeat the exercise for many years to come, refining it along the way.

If you don't measure performance, how are you supposed to improve? In Canada, we too often content ourselves with bromides about the quality of healthcare rather than looking at the hard numbers.

We also labour under the illusion that we have a national health system. We don't. There are 14 different health systems in the country: provincial, territorial and federal (Ottawa is responsible for aboriginal peoples, the Canadian Armed Forces and the RCMP and it's unfortunate they are not included in the Conference Board report card.)

More than anything else, what the new report card shows is that there are significant disparities in the quality and performance of health systems between provinces. This is not overly surprising but it demonstrates, once again, that there needs to be some leveling of the playing field. This is a role that the federal government should play but does not.

The report card also serves up some reminders that we tend to conveniently forget:

• The amount of money we invest in sickness care is not necessarily reflected in population health outcomes. Alberta spends almost $4,600 per capita on publicly-funded healthcare and B.C. $3,700 but they get similar results;
• The provinces with the largest aboriginal populations have the worst health outcomes, a sobering reminder of the dire health outcomes in First Nations in particular;
• Similarly, the provinces with the worst marks – the D class – tend to rank poorly in the lifestyle category, meaning they have high rates of smoking and heavy drinking and low levels of physical activity;
• The provinces with the best health system performance – New Brunswick and Nova Scotia – don’t have the best overall health results.

Again, this interplay of factors underscores how socio-economic factors matter a lot more than delivery of medical care to overall population health.

The Conference Board has served up much food for thought for politicians, policy-makers and the public. If we content ourselves with looking at the A, B, and D marks and shrugging, as we tend to do when an analysis challenges the status quo, we will all deserve a big fat F.

André Picard is the health columnist at The Globe and Mail. In 2012, he served as the scholar-in-residence at the Conference Board of Canada but was not involved in the production of the report card.