Tax dollars producing little value for Canadians

The beginning of May marks the end of income tax season in Canada.

The beginning of May marks the end of income tax season in Canada.

While the task of completing our personal tax returns and the size of those tax bills slowly fades from our memories, some Canadians may find themselves taking solace in a belief that their taxes (of which income taxes make up about one-third for the average Canadian family) at least purchased a high quality universal access health care program.

Unfortunately, Canadian taxpayers are not receiving the same sort of value that their counterparts in other nations are when it comes to universally accessible health care, despite the fact nearly 60 per cent of personal income taxes paid in aggregate are required to cover the cost of Canada’s taxpayer-funded health care program.

First things first: Canadians are funding the developed world’s second most expensive universal access health insurance system.

On an age-adjusted basis (older people require more care) in the most recent year for which comparable data are available, only Iceland spent more on universal access health insurance system than Canada as a share of GDP, while Switzerland spent as much as Canada.

The other 25 developed nations who maintain universal health insurance programs spent less than we did; as much as 38 per cent less as a percentage of GDP in the case of Japan.

With that level of expenditure, you might expect that Canadians receive world-class access to health care. The evidence finds this is not so.

Consider the case of waiting lists.

In 2008, the median wait time from general practitioner referral to treatment by a specialist was 17.3 weeks in Canada.

Despite substantial increases in both health spending and federal cash transfers to the provinces for health care over the last decade or so, that wait time was 45 per cent longer than the overall median wait time of 11.9 weeks back in 1997. It was 86 per cent longer than the overall median wait time of 9.3 weeks back in 1993.

Canada’s waiting lists are also, according to the available evidence, among the longest in the developed world. For example, a 2007 survey of individuals in seven nations, six of whom maintain universal access health insurance programs, published in the journal Health Affairs found that:

• Canadians are more likely to experience waiting times of more than six months for elective surgery than Australians, Germans, the Dutch, and New Zealanders but slightly less likely than patients in the United Kingdom; and were least likely among the six nations to wait less than one month for elective surgery;

• Canadians are most likely to wait six days or longer to see a doctor when ill, and are least likely to receive an appointment the same day or next day among the six universal access nations surveyed; and

• Canadians are least likely to wait less than one hour and most likely to wait two hours or more for access to an emergency room among the six universal access nations surveyed.

That is hardly the sort of access you might expect from the developed world’s second most expensive universal access health insurance system.

By comparison, seven developed nations – Austria, Belgium, France, Germany, Japan, Luxembourg, and Switzerland – maintain universal access health insurance programs that deliver access to health care without queues for treatment.

Access to medical technologies is also relatively poor in Canada. In a recent comparison of age-adjusted inventories of medical technologies, Canada ranked 14th of 25 nations for whom data was available in MRI machines per million population, 19th of 26 nations in CT scanners per million population, 8th of 21 in mammographs per million population, and tied for 2nd last among 21 nations in lithotriptors per million population.

Clearly, Canada’s relatively high expenditures are neither buying quick access to care, nor are they buying high tech health care services for the population.

Governmental restrictions on medical training, along with a number of other policies affecting the practices of medical practitioners, have also taken their toll on Canadians’ access to care.

Among 28 developed nations who maintain universal approaches to health insurance, a recent comparison found Canada ranked 26th in the age-adjusted number of physicians per thousand population.

It should come as no surprise that Statistics Canada determined that nearly 1.7 million Canadians aged 12 or older could not find a regular physician in 2007.

While our taxes can and do pay for important and valuable services for all Canadians, we need to critically assess whether or not we are receiving value for the dollars we are spending. In the case of health care, Canadians are paying for a world-class health care system but are not receiving one in return.

Hopefully, this knowledge will encourage Canadians to think more carefully about the need for substantial reform of Canada’s failing approach to health care policy.

Nadeem Esmail is the director of health system performance studies at the Fraser Institute.

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