OECD quality of care data: how Canada ranks

How well does the system do when it comes to keeping people out of hospital, and caring for those who end up there?


Lively debate has raged over our cover story last week on health care. Sorting out where Canadian care stands in international comparisons is no simple matter. For anyone with an appetite for data on this subject, I suggest the OECD’s Health at a Glance 2009 document.

The way the OECD separates statistics into categories helps keep different parts of the argument straight. For instance, figures that have to do with society, like those for traffic fatalities and suicides, are gathered under a separate heading from stats that have to do with the health system itself. So are numbers like how many people are overweight or smoke.

The OECD groups together data about access to care and the health workforce, and also statistics on spending on care. All worth close attention. But for the purposes of determining how well Canadian hospitals, clinics and doctors’ offices perform, some of the most immediately useful numbers are those you’ll find in the “Quality of Care” section. How well does the system do when it comes to keeping people out of hospital, and caring for those who end up there?

These numbers aren’t about the underlying healthiness of the population, or with stresses and strains in the funding of the system. They’re about what actually happens to those who clearly need care. As the OECD puts it, these numbers are meant to provide some help in answering the question, “Which areas of the health care system are providing value-for-money and which show opportunities for performance improvement?”

Here’s a quick look at how Canada ranks on 14 “Quality of Care” numbers the OECD highlights. In most cases, the OECD has data for about twenty countries.  Canada ranks below the average of the club of developed economies on two of these fourteen indicators:

1.    Dying in hospital after a heart attack: Canada ranks fifth best

2.    Admission to hospital for asthma: Canada ranks second best

3.    Admission for diabetes: Canada ranks fifteenth (below average)

4.    Admission for congestive heart failure: Canada ranks fourth best

5.    Admission for high blood pressure: Canada ranks third best

6.    Dying in hospital after a stroke: Canada ranks nineteenth (below average)

7.    Unplanned readmission for schizophrenia: Canada ranks fifth best

8.    Unplanned readmission for bipolar disorder: Canada ranks sixth best

9.     Screening for breast cancer: Canada ranks seventh best

10.    Survival rate for breast cancer: Canada ranks third best

11.    Cervical cancer screening: Canada ranks fifth best

12.    Survival rate for cervical cancer: Canada ranks second best

13.    Survival rate for colorectal cancer: Canada ranks fourth best

14.    Flu vaccination rates for seniors: Canada ranks fifth best

(The only stats from the section that I’ve intentionally left out are those on childhood vaccination rates; these seem to me to be a mainly a function of public policy on when kids should get their shots, and so they don’t tell us much about the health system per se.)


OECD quality of care data: how Canada ranks

  1. It is a shame the cover story was more about hype than facts.

  2. This is a far better representation of what most of us actually experience when we use the Canadian health care system.

  3. In 10 of the 14 categories, Canada is ranked in the top 5. Not bad. Clearly we need improvement on Diabetes and Stroke care, but being in the top quartile of OECD countries in more than two thirds of the quality categories is nothing to sneeze at, especially as we've achieved this without the benefit of national pharma and homecare strategies. As for our health system: Keep improving, but don't tear it down as it's working for the most part.

  4. The really useful part of these studies must be the details, not the headlines. If Canada's health care system is pretty good overall, but comparatively weak at keeping stroke victims alive, then this study should encourage us to look at what the more successful countries do differently.

  5. We're #6! We're #6! Hurray!

    Take that Number 7!

    Maybe someday, with all the money we're pouring into healthcare, we'll be #5!

    • The distance between # 1 and say # 6 is not stated. It is probably minuscule in some categories.

  6. Admission for diabetes: Canada ranks fifteenth (below average)
    Wait, do we really want to be admitting more people for Diabetes?

    On a more serious note:

    "Dying in hospital after a stroke: Canada ranks nineteenth (below average)

    this one has the hallmarks of being a transportation issue more than a care issue. I seem to recall reading somewhere that one of the larger issues here is the amount of time it takes to get stroke victims to the hospital; especially in rural communities and cites where hospitals have been built on the outskirts because of land availability – resulting in people having to be taken across town – or are now buried within the urban road network and facing traffic fights during peak hours..

  7. Maclean's covers are usually wildly sensationalistic, belying the quite decent content within. Must work for them.

  8. Maybe the outcomes are good once you get in, but that's not the problem. It's getting in. The numbers you cite are from OECD and probably a few years old. The decline in Canada has been rapid. Maybe OECD should frame a few questions like these:

    -Do you have a family doctor?

    -Have you experienced any routine medical conditions that required consultations from various specialists before treatment was carried out? (example – hernia, knee operation, etc).

    -Was it painful or disabling? How long did you wait between an initial visit to a doctor and a follow-up consultation with a surgeon or similar specialist?

    -How long did you wait for treatment by that specialist?

    -Have you visited an emergency ward recently. How long did you wait before treatment?

    The main point of the first article was that Canada fares very poorly when it comes to timely access to even average health care (and being in positions 4,5 or 6 is pretty average for a G8 country).

  9. This article does support my belief that Canadian medical staff are among the best in the world and are working tirelessly to provide excellent care. Once you access the care, the outcome is favourable.
    I too believe that the poor stroke outcome has to do with the geographical size of the country. Small rural hospitals do not have CT scans so there is no way to tell if the person is bleeding and what the best way to treat the stroke is.

  10. Long lines, not enough family doctors, no choice of doctors… Canadian health system is going down the drain. And the out of control immigration is accelerating the collapse of the system.

  11. I recently heard that by 2020 in Ontario 80% of the budget will need to go to healthcare. Here come the baby boomers.

  12. I am a Canadian who has lived in the UK and the USA for extended periods and thus experienced the medical care in three countries. I would rank the medical care that I received as follows: (1) USA, (2) UK, (3) Canada.

    The US system was not only best, it was head and shoulders the best. The cost for my wife and me was $10 thousand per year of which 80% was covered by my employer.

    The two tier UK system was excellent. All UK residents receive competent health care and those who wish and can afford it, may purchase additional insurance. The cost of the additional insurance was $2 thousand per year and this was covered by my employer. I never felt the need to use the services provided by the additional insurance. Appointments and tests were timely.

    Now back in Canada, i receive "free" health care, although it is a bit ridiculous to think that is free when $47 billion or 50% of Ontario's budget goes to health care. When experiencing chest pain in early October, I was scheduled for a stress test December 15 and for an appointment with a cardiologist in March. Fortunately, I kept the US insurance and when I mentioned this to my Canadian doctor, he advised me to get my butt across the border for treatment.

    This is a complex issue and my situation is not typical. It does, however, serve to point out two things: (1) Canadians need to give up the idea that they have the best system in the world that it must be maintained as is, and (2) it's all about the money.

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