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Jeffrey Simpson

And the worst record on timely access to primary care goes to … Add to ...

How satisfied are Canadians with the availability of quality health care? They're more satisfied with dissatisfied but less satisfied than people in most other advanced industrial countries.

According to Gallup's World Poll, 70 per cent of Canadians are satisfied. That's a lower satisfaction level, however, than in all the big European countries, Australia and New Zealand.

Canadians should be happier, if money spent on health care equalled high satisfaction levels. After all, leaving aside the United States with its largely private system, Canada is in the top bracket of spending in the Organization for Economic Co-operation and Development, at 10.4 per cent of GDP in 2008.

Canadian governments have been pouring money into the system. As the OECD's latest report shows, after-inflation annual growth in Canadian health-care spending from 2000 to 2008 rose 3.4 per cent, while GDP growth in the same period increased 1.4 per cent.

That 2-per-cent annual gap between health-care spending increase and GDP growth was higher than in any country except the U.S. and Britain. It also explains why health-care spending is pinching provincial budgets, even in provinces where the tax take has risen.

Money doesn't necessarily buy health-care happiness. In many other countries, the share of people who think "fundamental changes" are needed in their health-care systems has leaped from the early 1990s. In Canada, 60 per cent of survey respondents in 2007 said "fundamental changes" were needed in Canada, compared with 38 per cent who thought that way in 1990.

Governments run faster, spend more, sometimes make improvements, but sometimes fall behind. In Canada, for example, provincial governments have been buying lots more MRIs and CT scanners, but the country remains far, far below the OECD average for both.

Not surprisingly, therefore, in the country's largest province, the Ontario Health Quality Council recently reported that only one-third of MRI scans are being done on time. In a classic (and understandable) case of triage, the council found that high-priority cases were being dealt on time in 88 per cent of CT cases and 70 per cent of MRI ones, but "wait times have gotten worse for patients at lower priorities."

With all the money that Ontario has been throwing at its health-care system, a reasonable citizen might have expected better. (And what applies in Ontario quite likely mirrors what's happening in other parts of Canada.)

On the positive side, big improvements are reported in treating cardiovascular problems. Ninety-five per cent of patients get their surgical procedures within the recommended time frame. Diabetes, a growing scourge, is getting much more money and serious attention. Wait times have fallen for joint replacements and cataracts, two priority areas for Ontario funds.

But on the negative side - and these are depressing findings given the amounts of additional dollars being spent - the council found that "emergency department wait times are among the worst in the world." It said "a majority of patients did not get to see a doctor within the time frame recommended by national experts."

A huge systemic problem is allocation of hospital beds. A chronic shortage of long-term-care beds exists, so frail individuals who can't return home wait in hospital for space in a long-term-care institution. The council estimates that a staggering 16 per cent of hospital beds are occupied by those who don't need to be there - that is, they need a long-term-care bed. And, of course, with those beds being occupied in hospitals, it sometimes becomes hard to free up space for someone who needs to be there.

Cancer treatment is supposed to be a major area of improvement in Ontario, but the council reports that "only 53 per cent of urgent cancer cases are completed within the two-week target."

Then there's the old bugbear: access to a family doctor. Arguably, this part of the health-care system influences attitudes toward it more than anything else.

Reports the council: "Compared to 10 other countries, Ontario and Canada have the worst record on timely access to primary care." Yikes. In a system that eats up so many taxpayer dollars?

 

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