Evaluating Canadian Healthcare Performance
By Ben Eisen
(WINNIPEG, MB) – The Frontier Centre for Public Policy today released the fourth annual Canada Health Consumer Index (CHCI). The index ranks health care system performance from the perspective of the consumer in each province by assessing the extent to which they are meeting the needs of health care users.
The CHCI compares the ten provincial health care systems across five dimensions of quality. The dimensions of quality examined by the CHCI are:
- Patient Access to Information and IT Development;
- Primary Care and Problem Prevention;
- Wait Times;
- Patient Outcomes;
- Range and Reach of Services and Access to New Medications.
The report shows there are meaningful differences between the provinces in several of these areas. The following summaries briefly present the results for each province:
Ontario (1st): Ontario finishes in first place in this year’s rankings. Wait times are shorter than the national average in Ontario in most categories including orthopaedic surgery and cataract surgery. 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 compared to several other provinces. Ontario’s strong performance in the wait times category, combined with a strong performance in the heavily weighted patient outcomes category resulted in a fourth consecutive first-place finish for Ontario.
British Columbia (2nd-Tied): British Columbia finishes in a tie for second place in this year’s index, part of a distinct “first tier” with Ontario and New Brunswick. BC’s high score is primarily the result of the province’s strong score in the wait times category. BC earned the highest score of all the provinces in the wait times category due to relatively short waits for orthopaedic surgery, cataract surgery, and cancer radiation therapy. BC also earned points in the “Patient Access to Information” category for its impressive wait times website, which is among the most consumer-friendly in the country, providing timely and comprehensive information to consumers about wait times. However, in the patient outcome category, British Columbia’s performance was only middling, showing performance levels approximately equal to the Canadian average for most of the indicators examined.
New Brunswick (2nd- Tied): New Brunswick finishes a tie for second place, part of a distinct first tier with BC and Ontario. New Brunswick’s score is above average in the two most heavily weighted categories – patient outcomes and wait times. One area of weakness is that, on average, New Brunswick takes longer to include new medicines in its provincial reimbursement plan after Health Canada designates them safe and effective compared to several other provinces. New Brunswick’s wait times are either near the Canadian average or better than the Canadian average for every indicator examined in this report, which is a significant reason for its strong overall showing this year.
Manitoba (4th): After the top three finishers, the next six provinces finished relatively closely bunched together in terms of overall scores, forming a second tier behind Ontario, BC and New Brunswick. Manitoba finishes in fourth place in this year’s index. Manitoba fares relatively well in the Primary Care and Problem Prevention category. Manitoba finished in the middle of the pack in terms of wait times, an improvement over the early years of the CHCI, but some problem areas remain. Waits for hip-replacement surgery, for example, are still far too long. In the patient outcomes category, Manitoba’s performance was generally near the middle of the Index.
Alberta (5th): Alberta finished in fifth place as part of the large second tier. Alberta’s performance improved since last year, when it finished in seventh place. Its strongest category is patient outcomes. For example, risk adjusted AMI and Stroke 30-day in-hospital mortality rates are among the best in the country. Alberta performed less well in the wait times category. Far too many patients endure long delays for cataract surgery, for example. Waits for orthopaedic surgery and diagnostic imaging in Alberta were closely aligned with, but not better than, the Canadian average. Alberta’s strong performance in the patient outcomes category means that if it is able to reduce its wait times, the province would be able to contend with Ontario for the top spot in the overall rankings.
Newfoundland (6th): Newfoundland finished in sixth place, an improvement from last year, when it finished in last place. Newfoundland earned several good scores for wait time indicators. Specifically, a larger proportion of hip-fracture surgery patients received surgery within 48 hours of admission in Newfoundland than in most other provinces. Newfoundland fares less well in the patient outcomes category. The province has a high in-hospital 30-day mortality rate from strokes, which is statistically distinguishable from and higher than the Canadian average.
Prince Edward Island (7th): PEI finished in seventh place, near the middle of the large second tier. PEI remains the only province without a 24/7 Telehealth service, a fact that has a small negative impact on its overall score. PEI’s provincial wait-times Web site is of lower quality than those in most other provinces. An area of relative strength is the wait times category, where PEI outperforms a number of provinces.
Quebec (8th): Quebec finishes in 8th place, and is part of the second tier. However, it is difficult to form an accurate assessment of system performance because the province does not follow the national data collection standards for several of our indicators. As a result, the province was awarded a poor score in several indicators where its actual performance might be higher. We advise caution in interpreting Quebec’s score as an accurate measure of consumer-friendliness in the province.
Saskatchewan (9th): Saskatchewan finished in ninth place, a drop from sixth place last year. Saskatchewan fits into the second tier of provinces. However, it is important to recognize that the provinces in the second tier are clustered relatively closely together. The primary reason for Saskatchewan’s position near the bottom of the rankings is the province’s longer than average waits for care in several areas. Saskatchewan showed the second-lowest score of the 10 provinces overall in the wait times category. Saskatchewan earned a poor score for its wait times for emergency hip-fracture surgery, cataract surgery and hip-replacement surgery.
Nova Scotia (10th): Nova Scotia finished in last place. Its performance is near the Canadian average in several areas, but a poor score in the wait time category hurt the province’s overall score. A particularly problematic area is the long waits for orthopaedic surgeries. The government recognizes that it has a problem in this area, and it notes on its web site that it has the longest wait times in Canada for hip- and knee-replacement surgeries. We hope that recognizing the problem is a first step toward addressing it and that future CHCIs will report wait-time reductions in this and other areas.
“The results of this year’s index suggest that Ontario, British Columbia and New Brunswick form a distinct top-tier when it comes to delivering consumer-oriented healthcare in Canada. Each of the other provinces has at least one area of weakness that they need to address in order to catch up to those three provinces in future comparative evaluations,” says the study’s lead researcher Ben Eisen. “However, it is important to recognize that even our top performing provinces still have wait times that are typically longer than those experienced by patients in the European countries with top-performing healthcare systems like the Netherlands and Germany. Canadian governments spend a lot of taxpayer money on healthcare, and citizens are right to demand timely, world-class care. The CHCI is a tool designed to help citizens to hold governments accountable.”
Download a copy of the Canada Health Consumer Index 2011 HERE.