Comparing Canada’s health-care system with other countries, Part 5: Tying it All Together

Canada’s health-care system is finally beginning to return to some semblance of normalcy post-pandemic. However, many of us may have forgotten what normal actually looks like. While the challenges of the COVID crisis will have enduring repercussions, it’s important to also clearly understand how our system was performing in 2019 (before the pandemic) to separate systemic issues from more recent challenges. The previous four blog posts in this series did just that, each providing an in-depth look at Canada’s health-care spending, availability and use of resources, access to care, and clinical performance and quality. This final post summarizes the key findings from each blog to better understand the full pre-pandemic picture.

Part 1 of this series documented Canada’s health-care spending compared to 28 other universal health-care countries and found that Canada ranked second-highest in terms of health care spending as a share of the economy (after adjusting for age). Despite this high spending, Canada reported a significant relative scarcity of crucial medical resources. For example, Canada ranked 26th (out of 28) for physician availability and 25th (out of 26) for acute care bed availability. When it came to diagnostic technology availability, Canada ranked 22nd (out of 26) for CT scanners and 21st (out of 24) for MRI machines.

Table 1: Health-care Spending, 2019, Age-adjusted (Rank 1 = Highest Spending)
Indicator	Canada	Australia	Belgium	France	Germany	Netherlands	Switzerland	Countries
Health Care Spending (% of GDP)	2	9	6	5	4	12	1	28
Health Care Spending (per capita)	8	11	9	14	4	7	1	28

Canada did, however, manage to come in somewhere in the middle of the pack for nurse availability (14th out of 28) and reported the third-highest availability of Gamma cameras. Clearly, Canada has a relative scarcity of key medical resources compared to peer countries with universal health care.

Table 2: Availability and Utilization of Resources, 2019, Age-adjusted (Rank 1 = Best)
Indicator	Canada	Australia	Belgium	France	Germany	Netherlands	Switzerland	Countries
Physicians (per 1,000 population)	26	10	21	23	13	17	7	28
Nurses (per 1,000 population)	14	6	10	11	8	12	2	28
Acute Care Beds (per 1,000 population)	25	n/a	6	16	3	20	10	26
Doctor Consultations (per capita)	12	9	10	19	6	7	21	26
Hospital Curative Discharges (per 100,000)	27	4	8	12	2	26	11	27

Of course, measures of the overall availability of these medical resources (while important) do not provide information about their use. Which is why Part 2 of this series examined the relative rates of resource utilization. While we found that, after adjusting for age, Canada was a middle-of-the-pack performer when it came to physician consultations and diagnostic exams (CT and MRI) in 2019, the country came in last for hospital activity (measured by curative care discharges).

Canada also reported a relatively mixed performance on indicators measuring the volume of specific surgical procedures. For example, while Canada provided more coronary artery bypass grafts (CABG) per 100,000 population than nearly every other country examined (2nd out of 25), fewer hip replacements were delivered (19th out of 26). Of course, indicators measuring utilization of health care should be assessed with appraised need, but it’s safe to say that Canada is a mixed performer when it comes to the volume of services provided, in light of its relatively high spending.

Next in Part 3 of this series we reported on metrics of access to medical services. For primary care, such as the ability to get same day appointments or the ease of access to afterhours care, only 41 per cent and 39 per cent of Canadians reported in the affirmative ranking 9th and 8th out of 10 respectively. Canadian patients were also asked if they were able to access a specialist within four weeks (38 per cent said yes) and receive surgical care within four months (62 per cent said yes), with the country ranking last (10 out of 10) on both measures.

Finally, Part 4 of this series explored indicators of clinical performance and quality of care in the areas of primary care, acute care, cancer care, mental health care and patient safety. Overall, Canada had mixed performance on these measures, performing well on five while performing average or below average on seven.

Table 3: Timliness and Clinical Performance, Age-adjusted (Rank 1 = Best)
Indicator	Canada	Australia	Belgium	France	Germany	Netherlands	Switzerland	Countries
Waited less than 4 weeks for a specialist appointment, 2020	10	5	n/a	6	3	1	2	10
Waited less than 4 months for elective surgery, 2020	10	6	n/a	3	1	4	2	10
Breast cancer (five year net survival, 2010-2014, female, 15 years old and over, age-standardised survival %)	5	1	14	11	17	12	15	26
Admission-based Ischemic stroke 30 day in-hospital mortality, 2019, (Age-sex standardised rate per 100 patients; 45 years old and over)	17	7	19	16	12	6	7	27
Obstetric trauma vaginal delivery without instrument, 2019, (Crude rate per 100 vaginal deliveries, female, 15 years old and over)	20	16	5	n/a	11	16	14	20
Note: Lower rates are preferable. However, performances each indicator are ordered such that a rank of 1 indicates superior performance

The findings presented in this five-part blog series provide a clear picture of our health-care system in 2019, and what a return to this normal may look like. Unfortunately, the normal Canadian health-care system has relatively high spending, low resource availability and poor access to timely care (with a mixed record on utilization and performance). This suggests a clear imbalance between spending and performance, and poor value for our health-care dollars. Add in the additional pressures of health-care worker burnout and surgery backlogs that have accumulated over the last two years and it’s safe to say that our health-care challenges are far from over.