NCPA - National Center for Policy Analysis


November 28, 2005

According to the Canadian Healthcare Association, using total health expenditures to compare national health systems is misleading because it includes private spending by Canadians on items that are not generally covered by its public health care system. But that logic is faulty -- Canada's public expenditures are lower because many other nations publicly cover services that are privately funded in Canada, says Nadeem Esmail of the Fraser Institute.

To put it simply: individuals outside of Canada have more choice about where their medical care comes from and who will pay for it. This makes comparisons of only public or private health expenditures problematic, says Esmail:

  • In Sweden, the public health care program covers (in part) dental care and pharmaceuticals.
  • The German public program also provides coverage for these services as well as eyeglasses.
  • The French public program provides universal coverage for pharmaceuticals, while coverage for dental care and eyeglasses is more limited.

Clearly, there are large differences between what is and what is not publicly insured in developed nations; therefore, the most appropriate way to assess health spending is to compare total health spending to private expenditures on medically necessary services, says Esmail:

  • Compared to the 29 universal access health care nations in 2002, Canada spent 10.7 percent of gross domestic product on health care, ranking third behind Iceland (11.6 percent) and Switzerland (10.8 percent).
  • At the same time, Canada ranked 24th for access to physicians, 13th for access to MRI machines, 17th for access to CT scanners, 7th for access to mammographs and last for access to lithotriptors.
  • Canadians also tend to suffer longer waiting times for treatment.

Furthermore, an appropriate comparison of Canada and other nations shows that Canadians are spending a lot for health care and getting inadequate access in return, says Esmail.

Source: Nadeem Esmail, "Bad Statistics," Fraser Forum, September 2005, Fraser Institute.


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