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Jeffrey Simpson (Brigitte Bouvier for The Globe and Mail)
Jeffrey Simpson (Brigitte Bouvier for The Globe and Mail)

Jeffrey Simpson

The best health-care system? The numbers say otherwise Add to ...

One of the most comforting, yet debilitating, mythologies in Canada holds that we have the best health-care system in the world, or at least among the best.

Canadians desperately want to believe this assertion; hence its mythological status. Politicians have repeated the myth endlessly. The Romanow commission a decade ago stated, “Canada’s health system compares well with those of other wealthy industrialized countries.” Would that it were true then, or now.

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A host of studies shows the Canadian health-care system middle-of-the-pack at best, except for cost (private and public), where it ranks near the top. The studies use different methodologies and weigh factors differently. No single one is determinant, but most point in the same direction: The myth about Canadian medicare is just that, a myth.

Now here comes the latest study: from the U.S.-based Commonwealth Fund, reported in the journal Health Affairs in the form of a survey of general practice physicians in 10 wealthy countries, including 2,124 doctors in Canada. The comparative results for Canada are dispiriting, and it can’t be because Canadian doctors are sourpusses. Over 80 per cent of them reported satisfaction at practising medicine.

The results show, not surprisingly for those familiar with other international comparisons, how far behind Canadian medicare is in the modern age.

Here are a few examples from the 10-country survey.

Asked how many patients could get access to a next-day appointment, 22 per cent of Canadian doctors said it was possible, the lowest by far of the 10 countries. In France, it was 86 per cent, Switzerland 62, the Netherlands 61, Germany 56, Britain 55, and so on.

Asked whether their practice had arrangements for after-hours care, Canadian doctors stood second-last after the United States. The number in Canada was 45 per cent, compared to 94 per cent in the Netherlands, 90 per cent in New Zealand, 89 per cent in Germany, and so on.

These findings were consistent with those in a 2010 Commonwealth Fund study of patients that found Canadian patients were more likely to use hospital emergency facilities than patients in other countries, and to say they experienced difficulty in accessing health care after normal working hours.

Canadian family doctors reported the second-longest wait times for patients to see a specialist among the 10 countries. Canada had the third-worst score for the time taken in getting access to diagnostic tests.

We live in an electronic age, except for Canadian medicare, at least relative to other countries. Canadian family physicians had the worst record for responding to questions online; the worst for making appointments online; the worst for issuing refill prescriptions online.

For years, governments have been nattering on about electronic health records, and some progress has definitely been made. However, physicians’ answers in the 10 countries reveal that Canada remains mired in second-last place in use of such records (56 per cent) compared to over 90 per cent in Australia, Britain, the Netherlands, New Zealand and Norway, and 82 per cent in Germany.

As for the capacity of Canadian physicians to exchange patient summaries and test results with doctors outside their practice, Canada stood last. When it comes to the length of time for family physicians to receive information after patients are discharged from hospital, Canadian and French doctors experienced the longest delays.

Would nurse managers for cases help patients? Quite likely, but Canada has the third fewest. How are doctors doing? We can’t really tell, because Canadian family physicians report the third-lowest score comparing their clinical practice to established targets.

Okay, but what about outcomes? Isn’t Canada very good for health-care outcomes? Yes and no. Canada’s cancer outcomes are among the best in the world. But here are other outcomes, and where Canada ranks among 33 countries in the OECD: life expectancy 12th, diabetes incidence 8th, heart disease 12th. Amenable mortality (deaths avoidable by timely intervention) 12th of 27, infant mortality 27th of 40, hip replacements 21st, knee replacements 11th.

Agreed that anyone can play with numbers, and agreed to repeat that no one study is determinant. But nothing supports the myth that Canada has the best health-care system in the world. Rather, it would seem from a value-for-money perspective, our system leaves plenty to be desired.

 

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