Q: Is health care better in Canada?
A: Wait times are longer in Canada, but health and doctor quality don’t seem to suffer.
Is health care better in Canada than in the U.S., or is it true when they say universal coverage leads to long waits and a lower quality of care?
It is true that wait times for physician appointments and non-emergency surgery tend to be longer in Canada, which has a government-funded, universal health care system, than in the United States. A study by the Commonwealth Fund, a nonpartisan research foundation that promotes improved health care access and quality, showed that 57 percent of adults in Canada who needed a specialist said they waited more than four weeks for an appointment, versus only 23 percent who said so in the U.S. For emergency physician visits, 23 percent of Canadians and 30 percent of Americans said they could get in to see the doctor the same day, but 23 percent of Americans and 36 percent of Canadians waited more than six days. Wait times for elective and non-emergency surgery were even more disparate: Thirty-three percent of Canadians reported a wait time of more than four months, but only 8 percent of Americans had to wait that long. In another study, 27 percent of Canadians said that waiting times were their biggest complaint about their health system, versus only 3 percent of Americans. In October 2007, the Fraser Institute, a Canada-based libertarian think tank, reported that Canadians waited an average of 18.3 weeks between seeing a general practitioner and getting surgery or treatment.
However, on most measures of patient-reported physician quality, Canada comes out slightly ahead of the U.S. The Commonwealth Fund report shows somewhat fewer reported physician errors, lab errors, medication errors and duplicate tests north of the border, and Canadians report more satisfaction with their doctors. General health is also better up north, according to the World Health Organization: Life expectancy and healthy life expectancy are both higher in Canada; infant mortality is lower, and maternal mortality is significantly lower. There are fewer deaths from non-communicable diseases, cardiovascular diseases and injuries in Canada, though marginally more deaths from cancer. It’s not clear how much of the divergence is attributable to medical care, rather than other standard-of-living differences between the two countries. (For instance, according to the United Nations’ Human Development Index, Canada has a much higher school enrollment rate than the U.S., though it also has a lower GDP per capita.) But these statistics simply don’t support the notion that universal, single-payer health care is crippling the health of Canadian citizens compared with that of U.S. citizens.
Both countries, however, score low on health measures compared with other industrialized nations. In the Commonwealth Fund’s overall ranking of health system performance, Canada came in fifth and the U.S. came in sixth, out of six countries. On the other hand, the WHO’s 2000 World Health Report gave Canada a slightly better review, ranking it 30th for overall health system performance – above three of the other countries from the Commonwealth study (Australia, New Zealand and the U.S.) but below the other two (the U.K. and Germany). All of these countries, except the U.S., have publicly funded health care, as does every major country in the WHO’s top ten.
Update, Oct. 21, 2009: The 2000 WHO report has been questioned as out of date, ill-conceived and not always based on reliable data. See our Wire post on the criticisms for more.
Blendon, Robert et al. “Common Concerns Amid Diverse Systems: Health Care Experiences In Five Countries.” Health Affairs 22:3. 2003.
Esmail, Nadeem, and Dr. Michael A. Walker. “Waiting Your Turn: Hospital Waiting Lists in Canada, 17th Edition.” Fraser Institute. 15 Oct. 2007.
World Health Organization. World Health Report 2000. “Annex Table 1, Health system attainment and performance in all Member States, ranked by eight measures, estimates for 1997.” 2000.
World Health Organization. World Health Statistics 2007. “Health Status: Mortality.” 2007.