Are we getting value for money with Canadian health care? And, if not, what do we do about it?
A paper mulling the federal financing of provincial programs doesn't seem particularly interesting. But Jason Clemens is no ordinary author -- he's bright and his thinking is clear. Clemens worked at the Fraser Institute, served as vice president of an American think tank, and now works at the Macdonald Laurier Institute. Though only back in Canada for a few months, he's already penned a handful of papers. His latest, which considers the two questions above, is important. (The full text can be found here.)
Federal politicians promise more funding for the Canadian health-care system. After years of cuts, it was a Liberal government that pledged robust increases in health spending; Prime Minister Harper, campaigning for re-election this year, promised to continue the increases.
The result? The Canadian Health Transfer -- the primary federal funding mechanism for health care -- is expected to increase from just over $20 billion in 2006-07 to slightly more than $32 billion by 2014-15 - about a 60 per cent increase in under a decade.
But are we getting value for money?
Clemens looks at a variety of measures. He compares Canada to the other OECD nations. The results are startling.
Start with spending.
Canada is on the top end. But as Clemens points out, our sixth place ranking (tied with Switzerland) is a bit deceiving. Adjust for age and exclude the non-universal health-care system, and we spend the most of any country with a universal system.
How do we fare?
Consider the supply of physicians.
Clemens summarizes other data:
• Canada ranks 16th in access to nurses.
• Adjusted for population, Canada ranks 24th in hospital beds.
• Canada's wait times are also long compared to other industrialized countries. A study by the Commonwealth Fund indicated Canada performed the worst among the seven countries analysed. Of the seven questions aimed at wait times, Canada had the worst response in five and the second worst in the remaining two.
• Canada has comparatively middling performance in access to medical technologies. Canada ranked 16th out of 27 participating OECD countries for both access to MRIs and CT scanners.
• Canada ranks marginally better for access to mammograms: 11th of 25 countries.
Of course, there is more to comparisons than simply looking at, say, high-tech gadgets like MRIs. After all, when it comes to health care, more isn't necessarily better.
Still, even with this type of a crude comparison, Canadians clearly aren't getting value for money. And there's limited evidence that the sort of massive infusions of cash seen in recent years are making a material difference -- except that providers make better coin.
Clemens suggests a remedy. Using welfare reform as a model, he proposes that the federal government block grant health funding, turning the money over to the provinces, and allowing them to innovate.
It's a novel idea -- though I'm not quite as optimistic as he is. The reason that Ontario rejects user fees and Manitoba dismisses more private provision of health services has little to do with the federal government and much to do with the ambivalence of the Canadian people. Afraid of an Americanization of the system, Canadians fear change.
But looking at the OECD data, we see that Canadians could get more technology, shorter wait times, and still maintain a universal system. Where to look for ideas? Try Sweden or Denmark.
And, at the end of the day, is anyone really afraid of a Swedenization of the Canadian health-care system?