This is the third annual Canada Health Consumer Index (CHCI) produced by the Frontier Centre for Public Policy and the Belgian Health Consumer Powerhouse, this year in cooperation with AIMS. It shows three distinct leading provinces, but also tells of story of a health care system that needs help.
The study proposes three major policy recommendations for improving healthcare in Canada:
- Move away from global budgets to patient-based funding models for hospitals
- Cooperate with other jurisdictions in the approval of new medicines
- Introduce means tested co-payments
The index ranks health care performance in each province from the perspective of the consumer by assessing the extent to which the health systems meet the needs of health care users.
In the study, analysts from the Frontier Centre and the Health Consumer Powerhouse compare the ten provincial health care systems across five different “sub-disciplines:” Patients’ Rights, Problem Prevention, Wait Times, Patient Outcome, and Range and Reach of Services.
The report shows that there are significant and meaningful differences between the provinces in several of these areas. The following summaries briefly present the results for each province:
British Columbia: British Columbia finishes in second place in this year’s index, as part of a distinct “first tier” with Ontario and New Brunswick. As was the case last year, BC fared well in most categories, but once again did not succeed in the Patient Rights and Information category – largely because wait times for diagnostic imaging tests aren’t posted online. British Columbia performed particularly well in the wait time category, compared to other Canadian provinces. Waits for Cataract, orthopaedic surgery and cancer radiation therapy were all shorter than the national average. Performance for Patient Outcomes was also among the best in the country.
Alberta: Alberta, more than any other province, shows some areas of strength and other areas of real weakness. The province delivers good patient outcomes, ranking near the top of the country in that category. However, long waits for care badly hurt Alberta’s overall score. Wait times for cataract removal, radiation therapy and appointments with a specialist were all longer than the national average. None of the 8 indicators examined showed a wait time in Alberta substantially shorter than the national average. Albertans suffer from long wait times for care despite per-capita health care spending that is among the highest in the country.
Saskatchewan: Saskatchewan has shown some improvement since last year’s index, when it finished near the very bottom of the index due primarily due to long wait times. This year, Saskatchewan has caught up with several provinces and finishes in the second tier. The wait time situation appears to be improving somewhat. Waits for orthopaedic surgery are still too long and longer than the national average, but some improvement in the delay for knee replacement surgery moved the province from a rating of “poor” last year, to “fair” this year for that indicator. During the last reporting period, 59 per cent of knee surgeries in the province were performed within the 182 day national benchmark. Two years ago, only 37 per cent of knee surgeries were done within this timeframe. Clearly, there is still work to be done but this represents meaningful improvement. Waits for hip replacement surgery still reflected a “red” score. Reported wait times for cancer radiation therapy also improved significantly since last year’s report. Improvement is still needed, but Saskatchewan has made progress in some areas.
Manitoba: Manitoba finishes in the large second-tier in this year’s index. Wait times remain a problem for several indicators- waits for cataract removal and hip replacement surgery are among the longest in the country. For patient outcomes, Manitoba’s performance was generally middling – though it has a low rate of heart attack mortality. On the other hand, Manitoba also shows an unusually high rate of in-hospital hip fractures that is larger than, and statistically distinguishable from, the Canadian average. One the whole, Manitoba’s performance is mixed, resulting in the province’s mid-pack ranking.
Ontario: Ontario finishes in first place in this year’s rankings, with an overall score that is similar to British Columbia’s and New Brunswick’s in the clear top-tier. Its wait times are shorter than the national average in most categories including orthopaedic surgery and diagnostic imaging. However, an unusually large number of Ontarians reported waiting more than one month the last time they were referred to a specialist for a new condition. Primary care and problem prevention was a particularly strong area for Ontario. For example, a comparatively large number of Ontarians report having regular access to a family doctor.
Quebec: Quebec finishes in the middle of this year’s rankings- but it is difficult to form an accurate assessment because the province does not follow national data collection standards for several of the indicators examined. As a result, the province was awarded a “poor” score in several indicators where actual performance may be higher or lower. We advise caution in interpreting Quebec’s score as an accurate measure of consumer-friendliness in the province. Quebec generally performed very well in the wait times category, showing lower than average waits for Orthopaedic surgeries, specialist appointments and cancer radiation therapy.
New Brunswick: New Brunswick finishes in third place, part of a distinct first tier with BC and Ontario. New Brunswick’s performance is relatively strong in all of the categories, except for the range and reach of services category. Slow adoption of new medicines to the provincial reimbursement plan contributes to a low score in this category. New Brunswick’s score is above average in both of the most heavily weighted categories – patient outcomes and wait times.
Nova Scotia: Nova Scotia’s score is roughly in line with the Canadian average or slightly above in four out of the five categories, but a low score in wait times prevents Nova Scotia from joining nearby New Brunswick in the top-tier. Specifically, Nova Scotia has the longest wait times for orthopaedic surgery in Canada. Wait times for cancer radiation therapy are also longer than average. To break away from the pack and move into the top tier in future years, Nova Scotia will need to reduce its wait times in these areas.
Prince Edward Island: PEI’s performance is near the Canadian average in four out of the five categories, but Canada’s smallest province earns a low score for range and reach of services which has a slight negative impact on its overall score. For some indicators, it was impossible to formulate an effective score for PEI because the sample sizes were too small for Statistics Canada and CIHI to develop meaningful interpretations. In these instances, PEI was awarded an intermediate score so that there was no negative impact on its overall score or in particular categories..
Newfoundland and Labrador: Newfoundland and Labrador finishes in last place in this year’s index but is just fifteen points behind 9th place PEI, and just 51 points fourth place Manitoba. Newfoundland’s particularly low score was largely driven by its unusually low performance in the important patient outcomes section. Newfoundland’s unusually high infant mortality rate, readmission rate following hysterectomies and in-hospital stroke mortality rate all contributed to the province’s low score in this category and overall. It should be noted that based on our experience from past indices, the gap between last place Newfoundland and the other provinces in the second tier is quite small. These results should not be interpreted as showing a large gulf in consumer-friendliness between Newfoundland and the rest of Canada. They are best interpreted as showing a meaningful separation between the top three provinces on the one hand, and the rest of the provinces on the other.
“Canadian healthcare still has a long way to go in order to achieve the levels of consumer-friendliness that are taken for granted in much of Europe,” says the study’s author Ben Eisen. “Especially in terms of wait times, none of the Canadian provinces have reduced them to the levels seen in top European countries like the Netherlands and Germany. However, there are some signs of progress in this report in a number of provinces. By continuing to measure performance from the perspective of the consumer, the CHCI helps evaluate Canadian healthcare in a meaningful way and gives citizens the opportunity to see how their province compares to other parts of the country.”
To read the complete report, click here.