The Fraser Institute

The Fraser Institute

July 28, 2005 07:00 ET

The Fraser Institute: Media Release-Canada Spends Among the Highest on Health Care When Compared with Other Universal Health Programs but Ranks Low on Key Performance Indicators

VANCOUVER, BRITISH COLUMBIA--(CCNMatthews - July 28, 2005) - Canada spends more on health care than any other industrialized country providing universal access save Iceland and Switzerland, yet ranks low in measures of access to care, according to How Good is Canadian Health Care? An International Comparison of Health Care Systems (2005 Report), released today by The Fraser Institute.

"Canadians are being short-changed under our current health care system. Despite spending more than almost every other developed nation on health care, Canadians are experiencing inferior access to physicians and technology and suffering very long waits for treatment. Canada is also less successful in reducing deaths from preventable causes than other developed nations," said Nadeem Esmail, co-author and senior health policy analyst at the Institute.

The study compares Canada to other OECD 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.

Many of the countries examined produce superior outcomes in health care and at a lower cost than Canada. Other industrialized countries with universal access programs, such as Sweden, Japan, and Australia, allow user fees, some form of private insurance, and private hospitals that compete for patient demand. These three countries consistently outperform Canada on health outcomes but spend less.

"This evidence supports the Supreme Court's recent conclusion that private health insurance does not need to be outlawed in order to 'protect' Medicare. It is striking to note that amongst industrialized countries, only Canada outlaws a private parallel health care system for its citizens," noted Esmail.

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 44 percent of health care expenditures yet make up only 12.7 percent of the population.

After adjusting for the age of the population, Canada spends 10.7 percent of GDP on health care, the third highest among developed nations with universal access health care programs.

Comparing Health Outcomes

In this study, seven outcome measures have been used to rank the performance of the OECD countries.

Canada ranks twenty-second in the percentage of total life expectancy that will be lived in full health; twentieth in infant mortality; twelfth in perinatal mortality; fourth in medically avoidable deaths; eighth in potential years of life lost to disease; tenth in the incidence of breast cancer mortality, and second in the incidence of mortality from colorectal cancer.

User Fees

The evidence presented in this study suggests that health care expenditures can be significantly reduced if consumers of care help to pay for the care they demand. In banning user fees, Canada is very much in the minority. 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, to all three. In most cases, low-income citizens are exempted from paying user fees.

The Number of Doctors

On an age-adjusted basis, Canada has among the fewest number of physicians in the OECD. Canada ranks twenty fourth out of twenty-seven countries with 2.3 doctors per 1,000 people for a total of 66,289 doctors. To be comparable to first-placed Iceland, Canada would need 53,663 more doctors, an 81 percent increase over the current level.

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 thirteenth out of twenty-two countries in access to MRIs; seventeenth of twenty-one in access to CT scanners; seventh of twelve in access to mammographs, and is tied for last in access to lithotriptors. Lack of access to machines has also meant longer waiting times for diagnostic assessment, and mirrors the longer waiting times for access to specialists and to treatment found in other comparative studies.

"It is astounding that Canadians continue to commit themselves to the status quo for Medicare, when other nations manage to deliver so much more for less money. We should be looking at incorporating successful policies from other countries, such as cost sharing and competition, in order to fix our ailing health care system," Esmail pointed out. "Canada should emulate these more successful models."

Established in 1974, The Fraser Institute is an independent public policy organization with offices in Vancouver, Calgary, and Toronto.

The media release and study (in PDF) are available at

To view the attached figures please click on the following link:

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