Canada’s troubled healthcare system

The proposed solutions I tend to hear concerning our healthcare troubles seem to fall into two camps. The first is that good healthcare is costly so we need to be prepared to spend more in the future for quality care. The other is that the reason the cost is so high is that consumers are not price sensitive, so we need to put the breaks on demand by imposing user fees of some sort.

Both of these outcomes sound right but the true story is more complex than that. A careful review of the Organisation for Economic Co-operation and Development (OECD) health statistics coupled with a heavy dose of research papers from various countries point to other problems with Canada’s healthcare system, problems we tend not to talk about much.

What’s our ROI?
First and foremost, given our sizeable expenditure on health, why don’t we have more to show for it? After adjusting for differences in demographics, the U.S. is the only country in the world paying more for healthcare than us. Yet, we have fewer doctors and nurses per 1,000 of population than most other developed countries, rank third quartile in the number of acute care hospital beds per 1,000 of population (behind Greece, Slovenia and Portugal among others), rank 17^th out of 26 OECD countries in the number of CT scanners per million and have fewer MRI machines per million than most OECD countries—including even Turkey.

That goes a long way to explain why the length of time from a referral by a family physician to final specialist treatment has nearly doubled since 1993. What it doesn’t do is explain where the money is being spent if not on doctors or equipment! Taxpayers should expect a better accounting of their healthcare dollars.

Part of the problem is that a national healthcare system is more of a religion than it is a business. This has been said to be true of National Health Services in the U.K. and is certainly true in the U.S. and Canada. As with any religion, one doesn’t always scrutinize its basic tenets too closely or rely solely on rational judgment. If we can’t articulate the purpose of our healthcare system, how can we expect to measure its performance? Is the ultimate purpose of healthcare to make sick people well, which implies a focus on acute care, or to maximize the number of people who are well, which implies more emphasis on prevention? Is it to strive for longer healthy life spans or to prolong any life at any cost?

I suggest we take our cue from the World Health Organization and define a healthcare system as something that has a primary purpose to promote, restore or maintain health. If we agree on that, the first observation is that our own system dwells too much on restoring health and too little on promoting and maintaining it in the first place.

The OECD statistics show very little correlation between how much a country spends on healthcare and on the overall health of its citizens. On the other hand, there is very high correlation between obesity and life expectancy; the higher the rate of obesity in a developed nation the lower the life expectancy of its people. This one factor alone explains why the Japanese can expect to live until past 82 while the Americans live only until 78, even though the U.S. spends nearly twice as much per capita on healthcare.

An estimate from the National Health System in the U.K. is that as many as 70% of hospital stays in that region stem from problems linked to lifestyle. In other words, they didn’t have to happen in the first place. Doesn’t that suggest we should spend more on preventative measures and less on further bolstering our acute care facilities?

The bottom line is that we don’t need to increase real spending on healthcare; we need to spend our money more wisely where it can have the greatest effect.