We would say, not very on both scores. Recent results from The Commonwealth Fund’s international health system ranking show the Canadian healthcare system fairs poorly compared to other developed nations. The 2017 results has Canada in 10th place among the 11 nations surveyed, with countries like Australia and the Netherlands among the top tier performers. However, more importantly the scores across many key dimensions such as timeliness of care and costs are in the lowest of the three tiers.
The rolling survey of patients, doctors and the public is conducted every three years and perceptions and experiences of Canadian healthcare suggest this year’s scores are a continuation of system weaknesses identified in 2014.
While one could argue this survey tool is somewhat of a blunt instrument given its forced ranking structure, the availability of provincial data sets allows for eye opening domestic comparisons. These comparisons highlight the areas and extent of provincial shortcomings and point an encouraging finger to look for answers at home.
The metaphor of the safety net captures the reactive versus proactive nature of the Canadian system as evidenced by the low scores across the provinces on access to primary care physicians and the high number of visits to the emergency department by people with conditions that could have been treated by a regular family doctor. The burden placed on emergency services creates holes in the net rendering the system unsafe.
Policy makers and innovators may want to innovate using a new metaphor. These results point to the potential of the metaphor of ecology as a serious contender. We need to look at the problems and the competencies. We need to see the provincial systems in the context of the larger Canadian setting. Let’s be inspired by such ecological terms as adaptive, endangered, renewable, sustainable, interdependence, community and mobilization.
This blog is the first of three on healthcare in Canada.