Year after year, poll after poll we see that health care is considered far and away to be the most important issue to Albertans whether left, right or center. We also see constant stories of shortcomings in our current system. Recently we have literally seen a doughnut shop being used as an ER because a BC hospital was over capacity. People have been literally dying on waiting lists and we are seeing health facilities in dire need of upgrading or repair.
Two facts are evident here. One is that health care is paramount in importance to Albertans and that the system is not performing in a satisfactory way. People say that they want the “best”. OK fair enough but how do we determine what is actually the best? Lets look at a few measures.
Almost invariably when shortcomings are pointed out in the system, defenders of the status-quo (unions) suddenly claim that our system is one of perfection and that we simply are underfunding it.
Alberta has tripled health care spending in the last decade. Despite that massive increase in expenditure, our waiting lists continue to grow and our infrastructure continues to crumble. if spending alone were the measure of a successful system, the United States are clearly the most successful health care providers on the planet as they spend more by every measure on health care than any developed nation on the planet.
Many health systems that can brag better results than Canada spend less in measures of per-capita spending and in percentage of gross domestic product. It is pretty safe to say that this means that we can see better results in health care without spending more money if we are willing to change how we do things.
It must be kept in mind that the most vocal groups for increased spending are unions and their side lobby groups (Friends of Medicare). Despite what they may claim, unions simply do not have the interests of patients in mind (nor should they, the workers are their mandate). Note that the unions constantly call for “more beds”, not more doctors, more procedures, more drug coverage, more preventative medicine or more diagnostic equipment. The reason for this is simply that more beds translates into more union staff whether nurses, janitorial or even in laundry services. If we got all of the other things, we would need less beds as people would not be languishing in hospitals awaiting treatment as they are now. The unions are simply doing their job in that their interest is nothing more than gaining and maintaining more union workers. That always has to be kept in mind when they call for more spending in health however.
World health spending rates can be found here. Canada is near the top in this at least.
Beds per 10,000
While beds and the need for them can represent a shortcoming in timely treatment, we certainly do need a measure of them. As Canada is among the world leaders in spending, how do we rank among beds? Not too well I fear.
Canada ranks 40th behind such economic powerhouses as Uzbekistan and Palau.
Again beds alone are pretty limited in what they indicate and in what they provide in health services. All the same, if we are going to lead in spending, why are we not leading in such measures as this?
One thing that greatly reduces the need for hospital beds is having an adequate number of doctors and specialists treating patients so that they can be back on their feet again. An increased number of doctors helps reduce the load on the system by diagnosing and treating patients earlier while many conditions still remain more easily treatable.
Canada ranks 58th in doctors per capita behind such nations as Moldova and Uruguay with 2.1 doctors per 1000 people.
Gaining and maintaining doctors is not a simple task. Increasing the number of doctors we educate at home is good but it is no assurance that we will keep these recent graduates. Many newly trained Canadian doctors are quickly recruited by foreign countries that have more flexible health systems which are much more attractive to doctors than ours with essentially capped salaries and untenable hours of work. Our system hinders us in trying to draw foreign doctors in to Canada as well.
It only makes sense that we examine comparable countries to our own and that we emulate what has been working with them.
Many other factors come in when it comes to life expectancy. The local health care system has a huge impact on expectancies though.
In the world rankings, Canada is 11th in life expectancy. Not bad. I still like aspiring to the numbers of the 10 nations ahead of us though (all of whom have mixed health care provision systems).
Infant mortality is a good measure. Certainly we can’t directly compare with third-world nations that are coping with malnutrition, clean water and getting simple vaccinations. In developed nations though, the infant mortality rate can give a good indication of how the pre-natal and birthing care have been. In Canada we rank 23rd.
Universal care is a value that most Canadians share. Ironically, in our stubborn adherence to our flawed system many desperate Canadians are going to European and Asian nations in order to purchase procedures that they simply can no longer wait for in Canada. The irony is that these people are subsidizing the universal coverage of other nations while we languish with untenable waiting lists in Canada due to a twisted sense of “fairness” and an ingrained fear of “two-tier” care. Our socialized and rationed system is self-defeating in that people of means (or desperation) are still jumping the line and are taking their resources out of the country while they are at it. I wonder how many of these people end up getting treated by Canadian trained doctors in foreign nations? Which nations more truly have universal coverage?
We as Canadians have had it driven into our heads our whole lives that Canada has the best health system on the planet while every measure possible is contrary to that assertion. We have actually built a system of service provision into our national identity which is sort of disturbing when you think of it.
If we truly want to get the best health care possible for ourselves, we first have to admit that our system is not the best (in fact it isn’t even close to it). We then need to examine the systems that do rate as the best and emulate them.
In all of the measures I referred to above, some countries consistently ranked near the top. France, Japan, Sweden and Switzerland all surpass us and only Switzerland spends more. One common element of the countries that are surpassing us is that they have set aside the notions of envy and socialism in order to pursue the best outcomes for patients. All of those countries allow a much greater degree of private provision and management than Canada does and that is no small denominator in why those countries enjoy better care than we do at less cost to all. All of those countries have universal coverage as well.
When we look at the chronic crisis hitting Canada’s health system despite massive increases in expenditures, it becomes clear that change to Canada’s system is inevitable. What we have to ask ourselves is whether we want to proactively pursue that change now or if we will stubbornly hang on to our broken system until it collapses and change comes in a different way.
I would prefer to pursue the best system myself.