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Canadians Rate Quality of Healthcare System Low

The Toronto Star

April 14, 2006

Canadians rate their health care system lower than do people in five other developed countries, according to a new study.

But Americans, despite spending far more per capita on health, rate their health care system far worse than all the others, according to the study by the New York-based Commonwealth Fund.

The private foundation, which works to improve health care, released the study last week. It was based on adult patient surveys in 2004 and 2005 in Canada, the United States, Australia, New Zealand, the United Kingdom and Germany.

Patients ranked six measures and 51 indicators of quality: patient safety, effectiveness, patient centredness, timeliness, efficiency and equity.

Canadians ranked the timeliness of their health care lower than any other nationality surveyed, with more than a third of 1,400 surveyed saying they had to wait longer than six days for a medical appointment and 42 per cent waiting more than two hours to be seen in an emergency room. More than half of Canadians said they had to wait longer than four weeks to see a specialist and a third had to wait four months or more for elective surgery.

Rates of lab errors were also high in Canada, which tied with the U.S. for the number of patients who said they experienced a medical mistake in their treatment in the past two years.

"For all countries, responses indicate room for improvement," the report says.

A second survey of sicker adults, looking at health care by income in four of the countries, found Canadians with above-average incomes have to wait just as long as poorer patients and have the same difficulty getting care at night and on weekends and holidays without going to a hospital emergency room.

"Rates of ER use were highest in Canada and the U.S. - the two countries with the longest waits to see physicians and where individuals had the most difficulties getting after-hour care," the report says.

Canada also had the worst scores on test results. More respondents than in any other country said they didn't get test results back or didn't have them explained properly.

The U.S., the only country surveyed that doesn't have a public health insurance system, ranked last on providing health care to low-income adults, scoring the worst on 16 of 30 measures studied.

"Overall, the report finds a health care divide separating the U.S. from the other four countries," the report says. "The U.S. stands out for pervasive disparities by income."

The U.S. spends $5,635 per capita on health, more than double the average among industrialized nations. Canada spends $3,003 per capita, the second highest of the countries surveyed, but only a few dollars separated it from Australia and Germany.

Health policy analyst Michael Rachlis cautioned that the report's results are based on patient self-reporting and the answers "could mean different things in different countries.

"This is an index....Put it all together and you're getting an overall grade," he said in an interview. "It doesn't necessarily mean we have the fifth-best health care system. But the main point is, you can say absolutely conclusively that the U.S. has the worst health care system in the world, and they're spending by far the most. The other major conclusion, which is probably way more important, is that every country could improve dramatically."

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