The pandemic has brought the Canadian health-care system to its knees. Hospitals are routinely overwhelmed, medical professionals are on the verge of burnout, and the impact of surgical delays on non-COVID patients is mounting. While it may be comforting to assume these challenges will disappear when this pandemic ends, data from the pre-COVID world suggest this is wishful thinking.

A recent study by the Fraser Institute compares health-care data from 2019 (latest available) across 28 high-income countries with universal health care, examining 42 indicators of performance. It also provides data on health-care spending. By comparing how much Canada spends on health care in contrast to its performance on key indicators of health-care performance, the study provides a general picture of the value Canadians receive for their health-care dollars in what would now be considered “normal” times.

The study found that, after adjustment for age, Canada spent 11.3 per cent of its GDP on health care, which makes us the second-highest spender (a rank we also held the previous year). And yet, despite this high level of spending, Canada’s performance in terms of availability, utilization, timeliness and clinical performance was either modest or in many cases quite poor.

For example, according to the study, Canada had a relative scarcity for key medical resources such as acute care beds (2.0 per 1,000 population) and physicians (2.8 per 1,000 population)—ranking 25th of 26 and 26th out of 28 countries, respectively.

The study also examined the relative availability of medical diagnostic technology and found similar results. After adjusting for age, Canada ranked 22nd (of 26) countries for CT scanners, 21st (of 24) for MRI machines, 17th (out of 24) for PET scanners and 14th (out of 21) for mammographs. Canada did, however, perform much better on gamma camera availability ranking 3rd out of 23 countries.

Data on the utilization of resources are also generally grim. While the number of doctor consultations provided in Canada were comparable to the OECD average (ranking 12th out of 26), we came in dead last for curative care discharges, a measure of hospital activity, at 27th out of 27 countries.

The picture doesn’t improve when the study examines the utilization of diagnostic technology, with Canada ranking 17th out of 22 countries for MRI scans (with 64.4 scans per 1,000 population). Results were better, if still middling, for CT scans at 13th out of 22 countries (with 149.8 scans per 1,000 population). Clearly, Canada’s high level of spending has not translated into delivering a commensurate amount of medical services.

On the timeliness of care, Canada ranked 10th out of the 10 universal health-care countries where comparable data was available for timely access to specialist consultations (38 per cent waiting < 4 weeks for an appointment) and elective surgeries (62 per cent < four months) in 2020. Canada also ranked dead last on these two measures in 2016 (the last time these wait times data were collected and preceding the global pandemic).

Finally, the study also compared Canada’s clinical performance and quality among its international peers. Our performance in this category is mixed. For example, we performed particularly well in the areas of cancer care with survival rates for breast (88.6 per cent or 5th out of 26), colon (67 per cent or 8th out of 26) and rectal (67.1 per cent or 6th out of 26) cancer coming in at above the OECD average.

Unfortunately, Canada performed poorly on other indicators of clinical performance, reporting statistically higher rates of lower extremity amputation due to diabetes than the OECD average (ranking 19th out of 24 in terms of performance). And Canada reported the highest rates of obstetric trauma among the 20 countries where data were available.

Again, the data presented suggest that although Canada was one of the top spenders on health care in 2019, we did not receive commensurate value in return. Canada lagged far behind its peers on the availability of key health-care resources and struggled with long wait times even before COVID-19 hit. If Canadians want to return to an improved health-care system when the pandemic is over, policymakers must understand the costs and performance of our system now and in the future.