With the deadline for filing income tax returns now passed, some Canadians may still be in shock at the size of their tax bills, while others no doubt find solace in the belief that their taxes help pay for a high-quality universal-access health care system.
Unfortunately, they would be mistaken: Canadian taxpayers are not receiving the same sort of value that their counterparts in other nations are when it comes to universally accessible health care. This despite the fact some 68 per cent of personal income taxes paid in aggregate are required to cover the cost of Canada's taxpayer-funded health care program. In fact, Canadians spend much more for their health care and receive lower quality care than other countries with universal-access systems.
First, about the cost. Canadians fund the developed world's most expensive universal-access health insurance system. On an age-adjusted basis (older people require more care) in the most recent year for which there is comparable data available, no nation spent more on its universal-access health insurance system than Canada did as a share of GDP. The average nation with a universal system spent 21 per cent less than we did on health care (Japan spent 46 per cent less).
Now, about performance. With that level of expenditure, you might expect that Canadians receive world-class access to health care. The evidence suggests this is not so.
Consider the case of waiting lists. In 2012, the median wait time from general practitioner referral to treatment by a specialist was 17.7 weeks in Canada. Despite substantial increases in both health spending and federal cash transfers to the provinces for health care over the past 15 or so years, that wait time was 49 per cent longer than the overall median wait time of 11.9 weeks back in 1997. It was 91 per cent longer than the overall median wait time of 9.3 weeks back in 1993.
Canada's waiting lists are also, according to the available evidence, among the longest in the developed world. For example, a 2010 Commonwealth Fund survey of individuals in 11 nations, 10 of which maintain universal health insurance programs, found that Canadians were most likely to wait four months or more for elective surgery, were most likely to wait two months or more for a specialist appointment, were most likely to wait six days or more for access to a doctor or nurse when sick or needing care, and were most likely to wait four hours or more in the emergency room.
That is hardly the sort of access you might expect from the developed world's most expensive universal health insurance system.
Meanwhile, several developed nations including Belgium, France, Germany, Japan, Luxembourg, the Netherlands, and Switzerland maintain universal health insurance programs that deliver timely access to health care.
Access to medical technologies is also relatively poor in Canada. In a comparison of age-adjusted inventories of medical technologies undertaken for international health system comparisons, Canada ranked 15th of 24 nations for whom data was available in MRI machines per million population and 16th of 25 nations in CT scanners per million population. Clearly, Canada's relatively high expenditures are neither buying quick access to care, nor are they buying high tech health care services for the population.
Governmental restrictions on medical training, along with a number of other policies affecting the practices of medical practitioners, have also taken their toll on Canadians' access to care. Among 27 developed nations that maintain universal approaches to health insurance, Canada ranked 23rd in the age-adjusted number of physicians per thousand population.
While our taxes can and do pay for important and valuable services for all Canadians, we need to critically assess whether we are receiving full value for the dollars we are spending. In the case of health care, Canadians are paying the world's largest bill for a world-class universal health care system but are not receiving the services of one in return. Hopefully, this knowledge will encourage Canadians to think more carefully about the need for substantial reform of Canada's failing approach to health care policy.
Nadeem Esmail is Director of Health Policy Research at the Fraser Institute.