The Fraser Institute

The Fraser Institute

December 18, 2006 06:00 ET

The Fraser Institute: Media Release; Canada Among Top Spenders but Access to Health Care Still Ranks Behind Other Nations

CALGARY, ALBERTA--(CCNMatthews - Dec. 18, 2006) - Canada's universal-access health care system comes with high-end costs but delivers bargain basement results when compared to universal-access systems offered in other countries, according to a new study released today by The Fraser Institute.

"Canada spends more on health care than any industrialized country other than Iceland when spending is adjusted for age of the population. But despite the significant sums of money we throw at our health care system, we wind up with longer waiting times and inferior access to technology and physicians," said Nadeem Esmail, Director of Health System Performance at The Fraser Institute and co-author of the study.

How Good is Canadian Health Care? An International Comparison of Health Care Systems (2006 Report) compares Canada to other OECD (Organization for Economic Co-operation and Development) countries that guarantee access to health care regardless of ability to pay. Twelve indicators of access to health care and outcomes from the health care process are examined including access to physicians, access to high-tech medical equipment, and key health outcomes. The United States and Mexico are not included in the study because they do not have publicly-funded, universal-access systems.

One of the key differences between Canada and other industrialized nations with universal access to health care is that Canada is one of the few countries with no user fees and the only country that outlaws privately funded purchases of key health services.

"The countries that produce superior results at a lower cost than Canada's monopoly-insurer, monopoly-provider system have user fees, alternative, comprehensive, privately funded care, and private hospitals that compete for patient demand," Esmail said.

"Evidence clearly shows that that health care costs can be significantly reduced if consumers have to pay for a portion of the care they demand."

Health Care Spending

The average age of a country's population is a major determinant of the amount of money it will have to spend in order to provide adequate health care. In Canada, those aged 65 and over consume more than 45 per cent of health care expenditures yet make up only 13 per cent of the population.

When spending is adjusted for age, Canada spends more on health care than any other OECD nation except Iceland. Countries that spend significantly less than Canada include Japan, Italy, the United Kingdom, and Sweden.

User Fees and Private Providers

More than three-quarters of the countries in the OECD that provide universal access also charge user fees for access to hospitals, general practitioners, or specialists and in many cases, for all three. In most cases, low-income citizens are exempted from paying user fees. Additionally, every other OECD country has some form of user-pay, private provision of health care. While many OECD countries rely primarily on public hospitals to provide publicly insured services, more than half of the countries permit private providers to deliver publicly funded care.

The Number of Doctors

On an age-adjusted basis, Canada has among the fewest number of physicians in the OECD. Canada ranks 24th out of 28 countries with 2.3 doctors per 1,000 people for a total of 66,583 doctors. Only Turkey, Japan, the United Kingdom and Finland have fewer doctors. To be comparable to first-place Iceland, Canada would need 57,071 more doctors than we had in 2003. In 1970, when public insurance first fully applied to physician services, Canada placed second among the countries that could be ranked in that year.

Access to Technology

In terms of age-adjusted access to high-tech machinery, Canada performs dismally. Canada ranks 13th out of 24 countries in access to MRIs; 17th of 23 in access to CT scanners; seventh of 17 in access to mammographs, and 18th of 20 in access to lithotriptors. Lack of access to machines has also meant longer waiting times for diagnostic assessment and mirrors the longer wait times to access specialists.

Comparing Health Outcomes

In this study, seven outcome measures have been used to rank the performance of the OECD countries. Canada ranks 16th in the percentage of total life expectancy that will be lived in full health; 21st in infant mortality; 14th in perinatal mortality; ninth in potential years of life lost to disease; fourth in mortality amenable to health care, 10th in the incidence of breast cancer mortality, and second in the incidence of mortality from colorectal cancer.

"All the countries that have fewer years of life lost to disease and a lower mortality rate amenable to health care than Canada also have private alternatives to the public health care system and user fees at the point of access to care," Esmail said. "With this overwhelming evidence, why do so many Canadians refuse to even consider options other than our current single payer, government-driven monopolistic health care system? Other countries have created working, successful health care systems at lower cost and we should be looking to emulate that success rather than fighting at every turn policies that other countries have clearly shown can provide benefits."

Established in 1974, The Fraser Institute is an independent public policy organization with offices in Vancouver, Calgary, and Toronto. This news release and the complete study are available at

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