There is a reflexive retort whenever Canada’s failing healthcare system is criticized – at least we’re better than the United States and its profit-before-patients system. That lazy comparison obscures an uncomfortable truth: most developed countries do a better job at providing health care to their citizens than does Canada, often at lower cost.
The Netherlands always scores highly in international rankings, as do the Scandinavian countries, Singapore and Japan. But the system that Canada could study most profitably might be Australia’s.
Like Canada, Australia is a former British colony that occupies a large territory, with the population mainly clustered in urban centres. Like Canada, Australia adapted Britain’s Westminster parliamentary system to a federal system that, in Australia’s case, includes a Commonwealth government, six states and two territories. And like Canada, Australia’s multicultural society includes an Indigenous population, descendants of the original settlers and more recent immigrants.
An unhealthy debate
This is part of a series on our health-care system, and the challenges in diagnosing and fixing its problems, as explored in The Globe’s Secret Canada project.
Broken promises: The ‘universal’ model is anything but
Data: Lack of clarity is unacceptable
Lessons from abroad: Health care, Australian-style
Justice: Defining the duty of care
Accountability: What patient power can achieve
According to data compiled by the Organization for Economic Co-operation and Development, Australia spends less on health care than Canada: 9.6 per cent of GDP for them compared with 11.2 per cent for us. Yet Australia has more practising physicians than Canada – 4.0 per 1,000 people there versus 2.8 here – and also more hospital beds: 3.8 per 1,000, compared with 2.6.
Australians smoke and drink more than Canadians, yet their rates of diabetes and obesity are lower and their average life expectancy is 83.3 years, while Canada’s is 81.6. Overall, 71 per cent of Australians say they are satisfied with their access to health care, while only 56 per cent of Canadians say the same.
The Commonwealth Fund, an American non-profit, ranked Australia number one among 10 developed countries that it studied in its latest annual report. Canada ranked seventh, while the United States came in a very distant 10th.
Healthcare in Australia is delivered differently from Canada in three major ways. First, the Australian federal government largely funds primary care, while also providing grants to state and territorial governments, which are responsible for public hospitals. In Canada, the provinces are largely responsible for funding and managing health care, though about a quarter of those funds consist of grants from Ottawa.
Second, citizens in Australia are encouraged to take out private health insurance, which can deliver lower wait times and better service. Upper-income Australians are charged a surtax if they fail to acquire private insurance.
Third, while Australia has a national pharmacare system, which Canada is only now beginning to develop, patients are charged fees for prescriptions, as well as for some other medical services. There are government programs to assist patients who can’t afford to pay some or all of the fees. The Canada Health Act prohibits extra billing of patients.
The federal government in Canada provides health services to First Nations communities and to Inuit. The federal government of Australia has a similar responsibility for Aboriginal and Torres Strait Islander peoples. Both governments have done a poor job, with Indigenous Australians and Canadians suffering higher rates of disease than the general population, and having a substantially lower life expectancy.
Both progressive and conservative reformers might cite Australia to bolster their cases. Those on the left might point to its pharmacare program. Those on the right might promote Australia’s private insurance plans and user fees.
The truth is, political systems evolve uniquely. Canada might have a more efficient and effective health care system if the federal government were mostly in charge. But our Constitution and history have given the provinces a greater say.
In this country, universal public health care is a value as well as a service – whatever its flaws. But those flaws do not disappear simply because Canada has avoided the worst inequities of the U.S. system.
Comparing Canada’s health care only to that of the United States blinds us to the best practices of others that might be the starting point for much needed reform in this country.