The Conference Board is having a Summit on Sustainable Health and Health Care October 30th and 31st in Toronto featuring a plethora of media, industry, health service and academic experts who will focus on the need to refocus the health system “from treating acute illness to preventing and managing chronic disease so governments, healthcare leaders and businesses need to combine forces to help all Canadians lead healthier lives.” They will discuss the transformation of health care, inequalities in health care, workplace wellness initiatives, health management, intelligent funding, end of life decisions and health and the social media revolution. It all sounds like a really swell time. There will probably even be a couple of nice meals and lots of social networking. Here what they should also be discussing – where is the value for money in Canada’s health care system?
Are we at least in the forefront when it comes to health outcomes? When it comes to life expectancy at birth, we rank 13th at 80.8 years. Japan, which ranks 19th in per capita total health spending, is first in highest life expectancy at birth at 83.0 years. As for infant mortality, Canada’s is in 27th place at 5.1 deaths per 1,000 live births. Meanwhile, Iceland is in first place at only 2.2 deaths per 1,000 live births – but ranks 16th in the amount of per capita total health spending. In terms of obesity, we are also a world leader with one of the largest percentages of total adult population with a BMI greater than 30. The least obese OECD country is Korea which also ranks 27th in terms of the amount of total health spending per capita. When it comes to suicides per 100,000 population, we rank 13th at 11.1 per 100,000 population. The lowest numbers of suicides per 100,000 of population is Greece but ranking 22nd in terms of health spending. When it comes to overall cancer mortality rates, the OECD data shows the lowest rates are in Mexico, Sweden and Israel but Canada ranks in about the middle.
I suppose you could make the case that these comparisons use very aggregated data and that given the social, cultural and economic differences even amongst the developed OECD countries, we are comparing apples with oranges. Moreover, Canadians are very satisfied with their health care system. Indeed, the OECD numbers also show that when it comes to self-reported health status, Canada ranks very highly in terms of the proportion of population aged 15 and over reporting that they are in good health (3rd highest in fact). If we feel so good about our health status, how can one argue that we are not getting value for money in our health care system?
Yet, I am still perturbed by the results of these comparisons. Borrowing a line from the Globe and Mail, it is indeed our time to lead when it comes to health care but we seem to be leading in the wrong way. We spend a lot, buy relatively less in the way of health system resource inputs and do not get as much in terms of health outcomes. Where is our value for money? Granted, when it comes to life expectancy we are doing well – we get 80.8 years. But why does Japan get an extra 2.2 years (2.7 percent more years) while spending $1,410 per person (32 percent) less? As for infant mortality, we are really not that much higher than most countries and we are certainly not Mexico or Turkey. On the other hand, Iceland had an infant mortality rate that is 57 percent lower while spending 26 percent less per capita on total health spending. It is not that we have a poor health care system. Our outcomes are good on a world scale but relative to the OECD as a comparison group we could do better. How do we do that while also spending less?