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Poor health-care ranking a sign our system needs fixing

Canada ranks ninth among 11 wealthy countries whose health-system performance was examined by the Commonwealth Fund, a U.S. think tank.

Should we bemoan the fact that the medicare system in which we take such pride is third-last? Should we take comfort knowing that we have slithered up from second-last – and that we will never be bested by the perennial bottom-dwelling U.S.?

Or does this type of international comparison matter at all?

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Let's start with the latter: The new Commonwealth Fund report, entitled "Mirror, Mirror 2017," does matter, especially because Canada does a dismal job of self-analysis.

Related: Canada ranks third-last in study of health care in 11 rich countries

We produce a plethora of reports, on everything from wait times to spending, but no real report card that brings it all together to provide an overall analysis of the strengths and weaknesses of medicare, either provincially or nationally. As a result, we have no priorities for improvement and reform, and no impetus to change.

The Commonwealth Fund report, if nothing else, provides a modicum of public shaming, a reminder that a lot of countries do a better job of providing universal health care to their citizens, and they do so more cheaply than Canada.

What matters most is not where we rank – 10th, or ninth – but understanding what the top-performing nations – the United Kingdom, Australia and The Netherlands – do better than Canada.

The Commonwealth Fund gathers data from a variety of sources, pulling together 72 indicators grouped into five domains: care process, access, administrative efficiency, equity and health-care outcomes.

Canada ranks relatively well – meaning mediocre, not poor - in two categories: care process and administrative efficiency.

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We provide excellent medical care that is as good as anywhere in the world; when you're in the right place at the right time, the care is appropriate and safe. The not-totally-damning administrative efficiency ranking may surprise some – after all, we complain incessantly about bureaucracy – but this principally reflects that the single-payer system for hospital and physician services is simple and cost-effective.

That Canada has the worst access in the developed world will surprise no one. Waiting is a hallmark of our health system, from primary care through to admission to long-term care. That so many other countries can provide timely care at lesser cost should underscore that there is no excuse for our dismal performance.

What may surprise many is that Canada ranks so poorly (nine of 11) in what are arguably the two most critical areas, health outcomes and equity.

Canada has a dismal record on child mortality – with a rate more than double that in Nordic countries. It also has a relatively unhealthy adult population, with one in seven suffering from more than two chronic conditions.

The most shocking metric of all, however, has to be that Canada's beloved medicare system is inequitable. Bluntly stated, we are failing to deliver care reliably and affordably to all those who could benefit.

The problem is that Canada does not cover a broad enough range of services. Medicare covers 100 per cent of hospital and physician services, but too often fails to cover essential prescription drugs, home care, long-term care and dental care, which is the norm in most wealthy countries.

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The Commonwealth Fund report provides a timely reminder that our definition of "universality" is outdated.

One of the other key lessons of the analysis is that how health systems are funded doesn't much matter. The top-performing countries have wildly varying funding methods, from Australia's single-payer system through to the Dutch approach of mandatory private health insurance. But they excel because delivery of care matters to them more than the financing method.

The countries that consistently perform better than Canada have another common trait – they focus on the fundamentals.

The best health systems have three common traits: They emphasize primary care (ensuring everyone has timely access to a family physician or clinic), their health-insurance programs cover a broad range of services and they invest smartly in social services (like housing, education and income redistribution) to reduce disparities and the need for sickness care.

There is nothing new or surprising here.

But the Commonwealth Fund report's title, "Mirror, Mirror 2017," is most appropriate and timely; it should lead us to recognize that, when it comes to providing health services to all, Canada is far from the fairest of them all.

Editor’s Note An earlier version of this article said that Canada “ranked best” in two categories: care process and administrative efficiency. This has been clarified to say Canada ranked “relatively well” in these two areas.
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About the Author
Public health reporter

André Picard is a health reporter and columnist at The Globe and Mail, where he has been a staff writer since 1987. He is also the author of three bestselling books.André has received much acclaim for his writing. More

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