Canada — we’re number six!

Canada’s health system was ranked last out of six public systems in an international survey that found only the United States delivering worse care to its patients. The private Commonwealth Fund, a group which advocates broader access to healthcare in the U.S., surveyed both patients and physicians on their experiences in seven countries.

The results are compiled in the 2010 edition of their ongoing report Mirror, mirror on the wall: How the performance of the US health care system compares internationally. The highly-regarded Dutch system came in first place, closely followed by Britain and Australia. Germany and New Zealand lagged behind, with Canada bringing up the rearguard of public health systems. The US, predictably, limped in a distant last.

The US scored badly not just on access, efficiency and equity, but even on quality of care, a category in which it came sixth, with only Canada doing worse.

Canada’s great weaknesses will come as no surprise to anyone who lives here: primary care, primary care and primary care. The report reflects the growing belief among Canadians that if you haven’t got a GP now, you may never get one.

A corollary of this is overreliance on emergency services and lack of adequate preventive care. Wait times are an issue for patients, who also complain of lack of out-of-hours care. And Canada gets very poor marks for our patchwork adoption of electronic medical records.

Canada was actually the biggest per capita spender of the “socialised medicine” countries, at US$ 3,895 a head. New Zealand occupied the bargain basement at a paltry $ 2,454. Needless to say, the USA truly was Number One on this metric, blowing away all opposition with its awesome $ 7,290 per capita health spending.

The Canadian Medical Association’s president, Dr Anne Doig, told CanWest News that she accepted the findings, which matched those of other organisations. “These [Commonwealth Fund] reports are held to be reasonably accurate and methodologically sound,” she said.

Dr Doig agreed that primary care needs work and that electronic records should be adopted faster, but contended the problems go deeper than that. Canada needs a patient-centred system of care, she said. “One could argue the system serves itself rather than the patient.”

Canadians did well on the metric of “Long, Healthy, Productive Lives”, coming second behind Australia. But Dr Doig said: “Arguably, that is deteriorating. And if things don’t change, we might find we don’t do as well in another 20 years. We are essentially enjoying the benefits of reforms that happened in the ‘60s and ‘70s.” Transforming the health system is the CMA’s biggest single project these days, she noted.

Of course, the countries that get the most bang for their patient-centred buck, like Holland and France, also spend less on doctors’ salaries than Canada does. We’ll let you know when the CMA starts pushing for that reform.

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