The Fraser Institute’s Provincial Healthcare Index 2013 gives an unexpectedly favourable assessment of health care in provinces that are known for big-government policies, considering that it is a think-tank with strong limited-government views. In particular, the large central Canadian provinces emerge well; for instance, Ontarians have the shortest wait times.
It would be a mistake, however, to conclude that the Fraser Institute is endorsing Quebec’s or Ontario’s health-care policies. The author of the report, Bacchus Barua, makes it clear that he is not assessing policies. Yet the conclusions invite some such inferences. The “bottom line” of the study is about value for money; in other words, it is a comparison of the overall provision of health care with the cost. Quebec, according to Mr. Barua, has “the largest number of medical resources per capita,” yet spends the least on health care per capita. One recently departed premier (Jean Charest) and one outgoing Premier (Dalton McGuinty) can fairly claim some credit, having both had quite long terms in office.
However, evidence on patient safety and mortality in Quebec was not available, leaving a degree of uncertainty.
Alberta appears to have the greatest clinical effectiveness, but also the highest cost – a result that is not surprising, considering the overconfident spending in that province in the past several years. The present government is somewhat belatedly promising restraint for the next budget.
The poor assessment for Prince Edward Island probably is partly an expression of the lack of opportunities for economies of scale, in contrast to Ontario and Quebec. That constitutes a strong argument in favour of a high degree of sharing of services – health care and other spending areas – among the Maritimes provinces.
Newfoundland and Labrador also received a low ranking, which must partly reflect the province’s spread-out population – not a factor that Mr. Barua takes into account.
All provincial governments, however, should examine their policies in the light, or shadow, of this substantial study.