Of 28 countries with public health care, Canada among highest spenders, says Fraser Institute

But country ranks near bottom for number of doctors, hospital beds, MRIs and wait times

Despite spending more on health care than most other developed countries with universal health care coverage, Canada has some of the lowest numbers of doctors, hospital beds, and medical technologies and the longest wait times, concludes a new study released this month by an independent Canadian public policy think-tank.

We rank 21st out of 24

Among other things, the Fraser Instituite researchers found that Canada ranked 21st (out of 24) for the number of Magnetic Resonance Imaging (MRI) machines, with 10.5 MRIs per million people, and 22nd (out of 26) for CT scanners, with 15.2 scanners per million people.

Among the 10 comparable universal health-care countries that measure wait times, the study found Canada ranked last with the lowest percentage (38 per cent) of patients who waited four weeks or less to see a specialist, and the lowest percentage of patients (62 per cent) who waited four months or less for elective surgery.

‘A clear imbalance’

“There is a clear imbalance between the high cost of Canada’s health-care system and the value Canadians receive in terms of availability of resources and timely access to care,” said Bacchus Barua, Director of health policy studies at the Vancouver-based institute.

With policy analyst Mackenzie Moir, he co-authored ‘Comparing Performance of Universal Health Care Countries 2021,’which was published by the Fraser Institute on Nov. 2.

“Canada’s relative lack of critical resources and struggle with long wait times for treatment precede the COVID-19 pandemic,” said Moir. “To improve Canada’s health-care system in the post-pandemic world, policymakers should learn from other successful universal health-care countries, for the benefit of Canadians and their families.”

Health systems compared

The study compared 28 universal health-care systems in developed countries, spotlighting several key areas including cost, availability and use of resources, access to care, clinical performance and quality, and the health of Canadians.

In 2019, the latest year of comparable data, Canada’s health-care spending as a share of GDP (11.3 per cent) ranked second highest (after adjusting for population age) behind only Switzerland.

But despite Canada’s high level of spending, availability and access to medical resources is generally worse than in comparable countries (its performance in terms of utilization and quality is mixed).

We rank 26th of 28 for doctors

For example, (out of 28 countries) Canada ranks 26th for the number of doctors (2.8 per 1,000 people), 25th (out of 26 countries) for the number of hospital beds (2.0 per 1,000 people), and 24th (out of 28 countries) for the number of psychiatric beds (0.37 per 1,000 people).

The study used a “value for money approach” to compare the cost and performance of 28 universal health-care systems in high-income countries. The level of health-care expenditure was measured using two indicators, while the performance of each country’s health-care system was measured using 40 indicators representing four broad categories: availability of resources, use of resources, access to resources, and quality and clinical performance.

Second highest for costs

“Canada spends more on health care than the majority of high-income OECD countries with universal health-care systems,” the study’s authors wrote in an executive summary. “After adjustment for ‘age,’ the percentage of the population over 65, it ranks second highest for expenditure on health care as a percentage of GDP and eighth highest for health-care expenditure per capita.”

The data suggested that Canada has substantially fewer human and capital medical resources than many peer jurisdictions that spend comparable amounts of money on health care. They said that after adjustment for age, the country has “significantly fewer physicians, acute-care beds, and psychiatric beds per capita compared to the average of OECD countries included in the study.”

Performance below average

They said the country ranks close to the average for nurses and ranked eighth for the number of long-term care beds (per 1,000 over the age of 65). While Canada has the third most Gamma cameras (per million population, age-adjusted), they found it has fewer other medical technologies than the average high-income OECD country with universal health care for which comparable inventory data are available.

“Although Canada ranks among the most expensive universal-access health-care systems in the OECD, 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,” wrote Moir and Barua.