New report highlights Canada’s low health-care ranking among peer countries

A new report released by the Commonwealth Fund reveals the unpleasant truth about Canadian health care. According to the authors, it’s better than the star-spangled system south of the border—but worse than just about every developed universal health-care system in the world.

Canada’s poor performance (ranking 10^th out of 11 countries) is neither new nor surprising. In fact, Canada has secured a similar rank on every report released by the Commonwealth Fund since 2006 (when it ranked 5^th out of 6), the first time it offered an overall ranking. In subsequent years, even with the inclusion of more countries in the cohort, Canada steadfastly held the second-last overall ranking next to the United States (with a brief reprieve in 2017 when Canada ranked third-worst—hooray!).

In some ways, this year’s performance is particularly galling given that the report is missing several key measures of wait times performance, where Canada routinely fails miserably. Indeed, five indicators of timeliness of care were dropped in the 2021 report, either because they were unavailable or because the authors felt “the measure might be less valid because of effects of the COVID-19 pandemic.” Some of these included indicators measuring how long patients wait for specialist appointments and elective surgeries.

Given the importance of these data to Canadian patients, it’s worth documenting them for the benefit of readers. Fortunately, they’re accessible via other sources and reveal that Canada’s system ranked last on measures of timely access to specialist consultations (ranking 11^th out of 11) and for elective/non-emergency surgery (ranking 11^th out of 11) in 2020. While these figures might have been impacted by the pandemic, older data from Commonwealth Fund’s 2016 survey tell the same story. Specifically, Canada ranked (11^th out of 11) on very similar measures for both timely access to specialist care and elective/non-emergency surgery in 2016.

Basically, our health-care system received an overall failing grade despite the fact that we weren’t even properly tested on our worst subject.

The omission of these wait time data from the overall rankings is also important as Canadians and policymakers look to top performers in the Commonwealth Fund’s report for ways to improve our own system. For example, while Norway ranked 1^st overall, it also ranked 9^th and 10^th (out of 11) in wait times for specialist consultations and elective care respectively in 2020. While better than Canada’s, these rankings were worse than most other countries included in the report.

Clearly, however, every country included in the Commonwealth Fund’s report approaches universal health care very differently from Canada. Most expect patients to share the cost of treatment, and almost all of them fund hospitals based on activity and embrace the private sector as a either a partner (such as Australia and Switzerland) or an alternative (such as the United Kingdom and Germany)—policies either discouraged or effectively prohibited in Canada.

While defenders of the status quo will no doubt focus on Canada’s superior ranking relative to the U.S., those truly interested in progress should learn about every country that outperforms us in the Commonwealth Fund report and consider whether following their examples can help prevent repeated relatively poor performances in years to come, for the benefit of Canadians.