Healthcare Outcomes

An anonymous comment on Calgary Grit’s blog posted a statement that Canada is ranked 30th among OECD nations in health outcomes, but is third in spending on healthcare. I think he needs to wash his hands after where he obviously pulled that little gem.

I believe the source of this little dropping of wisdom was probably the Fraser Institute’s “How Good is our Healthcare.” But even they didn’t distort the data as badly as this. The Fraser Institute observed that:

Canada does not rank first in any of the seven healthcare outcome categories or in any of the comparisons of access to care, supply of technologies, or supply of physicians.”

Also – the report said that Canada was third in healthcare spending per capita among nations with universal access healthcare systems, which is why I am assuming that the anonymous poster was referring to this report. A report which concluded (as you could imagine considering its source) that Canada needed private healthcare.

If we break down the seven measure of general health outcomes used in the Fraser Institute report, here is how Canada fares against other nations.

• Infant Mortality : Canada ranks 20th among OECD nations with 5.2 deaths per 1000 live births. However let's look at the numbers. Is 5.2 deaths per 1000 live births (20th) significantly worst than 5.0 deaths per 1000 live births (15th – Australia)? Perhaps this is why if you go to the OECD report rather than the Fraser Institute version, they show these as whole numbers. Canada is still ranked 20th, tied with 8 other nations, but just behind 14 nations tied for 4th over all. When you rank things by fractional percentages you need to know the margin of error on the measures. In this case, the WHO used whole numbers which is a good indication of the accuracy of the measurements taken across countries.
• Life expectancy. Canada ranks 3rd on the OECD scale. The Fraser Institute however does not use this measure. Instead, they use Health Adjusted Life Expectancy (HALE) – where Canada ranks 7th and express this as a percentage of Life Expectancy (3rd over all) as a measure of the effectiveness of our healthcare system. By this measure (HALE/LE * 100) Canada ranks 22nd among OECD countries at 90.3%. Again, by ranking based on fractional percentages on a scale calculated from 2 different measures (calculated by the authors – not used by WHO or OECD) with god knows what margins of error, this tends to spread the scale. Is 90.3% (ranked 22nd) significantly worse than 91% (ranked 11th)?
• Perinatal (under 5) Mortality – Canada ranks 12th.
• Mortality (deaths per 100,000) Canada ranks 9th.
• Mortality Amenable to Healthcare (deaths per 100,000 from causes considered amenable to treatment in the healthcare system): Canada ranks 4th.
• Potential Years of Life Lost (a measure that gives more weight to mortality early in life) Canada ranks 8th.

So while the Fraser Institute was correct in saying that we did not rank first by any measure and ranked 22nd according to one hybrid measurement manufactured by the authors, of the indicators of gross health outcomes included in the OECD report, Canada only ranked out of the top 12 in 1 measure.

Here are some comparisons of specific outcomes across countries from the Commonwealth Fund five country comparison of Health Quality.

Australia:

• Breast cancer screening rates are higher than in other countries (+) [AU=74% vs. NZ=63%]
• 30-Day AMI (acute myocardial infarction) case fatality rates are lowest (+) [AU=7.3% vs. CA=11.1%]
• Childhood leukemia 5-year relative survival rates are lowest (-) [AU=69% vs. CA=81%]
• Pertussis incidence (whooping cough) per 100,000 people is higher than in other countries (-) [AU=31 vs. ENG=1.3]

Canada:

• Childhood leukemia 5-year relative survival rates are highest (+) [CA=81% vs. AU=69%]
• Kidney and liver transplant 5-year survival rates are highest (+) [kidney: CA=94% vs. US=83%; liver: CA=87% vs. ENG=71%]
• AMI 30-day case fatality rates are higher than in other countries (-) [CA=11.1% vs. AU=7.3%]
• Pertussis (whooping cough) incidence per 100,000 people is the second highest of the five countries (-) [CA=20 vs. ENG=1.3]

England:

• Suicide rates (per 100,000 people, all ages) are low compared to other countries (+) [ENG=6% vs. NZ=13%]
• Polio vaccination rates (age 2) are highest (+) [ENG=95% vs. NZ=82%]
• Five-year survival rates (relative) for breast cancer are lowest (-) [ENG=75% vs. US=86%]
• Five-year survival rates (relative) for colorectal cancer are lower than in other countries (-) [ENG=53% vs. NZ=65%]

New Zealand:

• Colorectal cancer 5-year survival relative rates are the highest (+) [NZ=65% vs. ENG=53%]
• Non-Hodgkins lymphoma 5-year relative survival rates are highest in Australia and New Zealand (+) [NZ=67% vs. ENG=58%]
• Suicide rates are highest, particularly among young people (rate per 100,000 people ages 15-19). (-) [NZ=25.1% vs. ENG=3.3%]
• Ischemic stroke 30-day mortality rates are highest (-) [NZ=11.8% vs. CA=9.0%]

United States:

• Breast cancer five-year relative survival rates are highest (+) [US=86% vs. ENG=75%]
• Cervical cancer screening rates are higher than in other countries (+) [US=93% vs. CA and NZ=77%]
• Asthma mortality rates (per 100,000 people age 5-39) are increasing (-)
• Kidney transplant 5-year survival rates are lowest (-) [US=83% vs. CA=94%]

You will notice that each country leads the other four in at least once indicator and lags the other four in at least one indicator. If you really want to of course you can dig and find some specific health outcome in which Canada lags other countries, but by all indications, Canada’s general healthcare outcomes are among the best in the world.