GOLDSTEIN: Health care expensive and inefficient before COVID-19

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Long before the COVID-19 pandemic hit, Canadians were paying for an expensive and yet severely stressed health-care system.

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The pandemic made things worse, but the underlying problems will persist after the pandemic is over.

A new study by the Fraser Institute, Comparing Performance of Universal Health Care Countries, 2021, assessing Canada’s system against 27 other comparable countries, points out the severity of the problems.

All 28 countries examined by Mackenzie Moir and Bacchus Barua are members of the Organization for Economic Co-operation and Development, have universal or near-universal coverage for core health-care services, and are classified as “high income” by the World Bank.

The U.S. is excluded because it doesn’t have universal health care.

Here’s how Canada fared.

Adjusted for the age of its population, Canada spends a higher percentage of its Gross Domestic Product on health care (11.3% in 2019) than any other country except Switzerland (11.4%). 

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On a per-capita basis, Canada spends the eighth-highest amount at $6,901.10 annually.

Despite that, Canada ranks 26th out of 28 countries in doctors per 1,000 population (2.8); 14th out of 28 in nurses (10.4); 25th out of 26 in acute care beds (2.0); 24th out of 28 in psychiatric beds (0.37) and eighth out of 24 in long-term care beds (54.3).

Canada ranks 21st out of 24 countries in MRIs per million population (10.5); 22nd out of 26 in CT scanners (15.2); and 17th out of 24 in PET (positron emission tomography) scanners (1.6).

Out of 10 OECD countries that track medical wait times, Canada ranked ninth worst in patients being able to make an appointment with a doctor on the same day they’re sick; eighth worst in finding medical care after hours; 10th worst in the time it takes to get an appointment with a specialist and to get elective surgery. (This was before the pandemic).

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On the quality of health care, the study found “while Canada does well on five indicators of clinical performance and quality (such as rates of survival for breast, colon and rectal cancers), its performance on the other seven … are either no different from the average or in some cases — particularly obstetric traumas and diabetes-related amputations — worse.”

The study found Canada finished seventh worst out of 10 countries when people were asked whether cost had been a barrier in their access to medical treatment over the past year.

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“Canada ranks among the most expensive universal health-care systems in the OECD,” the study concludes.

“However, its performance for availability and access to resources is generally below that of the average OECD country, while its performance for use of resources and quality and clinical performance is mixed. 

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“Clearly, there is an imbalance between the value Canadians receive and the relatively high amount of money they spend on their health-care system.”

A constant refrain of defenders of the status quo in Canadian medicare is that it’s far superior to the American system, and that the solution is to pour ever-increasing amounts of public money into medicare.

The fiscally-conservative Fraser Institute has long argued the major impediment to health-care reform is the prohibition in the Canada Health Act against cost-sharing measures with patients such as co-insurance, deductibles and co-payments.

It says many countries with comparable universal health care systems to Canada have used these mechanisms to deliver more effective and efficient health care, with lower costs to taxpayers.

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