Is Canadian health care as great as we like to think?
For many Canadians, our universal health care system is a source of national pride. But the head of a government-funded health care improvement organization says Canada’s system barely ranks above that of the U.S. and lags far behind systems in Europe, where taxpayers get more care for their money.
Maureen O’Neil is the president of the Canadian Foundation for Health Improvement, a not-for-profit organization funded by Health Canada to evaluate ways to improve our country’s health system.
She notes that experts weighing in on a global “health care tournament” voted to eliminate Canada in the first round. The tournament rankings, published in The New York Times, found that, while the U.S. health system is “a bit of a mess,” expensive and non-universal, that country excels in medical technology innovation, has few delays, and good outcomes for patients.
Canada, on the other hand, was found to have profound “access problems,” so that nearly one in five Canadian patients wait four months or more for elective surgery.
Sharing her take on CTV”s Your Morning, O’Neil is not sure she can agree that the U.S. health system is better than the Canadian system.
“We actually aren’t inferior to the Americans,” she said Friday. “In fact, if you look at all the comparisons that get made – by the Commonwealth Fund, by the OECD – Canada always does almost as badly as the U.S., but usually one or two (rankings) up.”
For example, a recent report by the Canadian Institute for Health Information (CIHI) using survey results compiled by the Commonwealth Fund found that Canadians experienced some of the longest delays to see specialists.
O’Neil agrees with the New York Times’ assessment that Canadians wait far too long to see specialists. But she says the other reason countries in Europe typically outperform Canada is because their systems are more integrated, offering many kinds of health services for free.
The NYT tournament noted that Canada and Britain, for example, both spend slightly more than 10 per cent of their GDP on health care, but the British system is able to offer more health care services to its citizens. Brits don’t need to buy supplementary health insurance the way many Canadians do if they don’t have health coverage at work.
“We don’t cover dentistry, we don’t cover physiotherapists, we don’t cover psychologists… We don’t have a broad enough range of things that we cover,” O’Neil said.
She says Canada has failed to create an actual, integrated health system; instead, we created a payment system. Our medicare system covers the costs of doctors’ visits and hospital care, but other things like medications and home nurses get left out.
Lots of possible solutions have been proposed over the years, and “just about everything” has been tried somewhere in Canada, O’Neil says.
She suggests one possible solution would be to make better use of home care and house calls, to keep more people out of hospitals and free up beds and resources for the most complicated cases.
“For example, if you’ve got lung disease, you can be helped at home much more effectively than at the hospital,” she said. “That reduces the likelihood of you racing to the hospital, breathless. And if you’re not in the hospital, we’re spending less money on you and can spend more on appropriate care for someone else.”
When it comes to reducing wait times, O’Neil says one solution could be in finding ways of eliminating the need for patients and specialists to meet face-to-face.
“We could have a system with a bank of specialists on call. A GP (family doctor) could call them and get advice within a day,” she said.
A review of a system in B.C. and Yukon called RACE (Rapid Access to Consultative Expertise) found family physicians reported that 85 per cent of the calls made to the hotline avoided face-to-face consultation and emergency department visits.
“So there are solutions out there that can be spread,” she said.