Commission on the Reform of Ontario's Public Services

Chapter 5: Health
Canada’s health care system is at its most public when it comes to physician and hospital
services; 91 per cent of the former and 99 per cent of the latter are paid for by governments.
But according to the CIHI, the public sector covers only 46 per cent of prescription drug
expenditures; private insurance pays for 36 per cent and out-of-pocket expenses make up
the remaining 18 per cent. Public coverage of the cost of other professionals’ services is
meagre — a mere seven per cent. Essentially, the medicare system of which Canadians are
so proud covers medically necessary hospital and physician services, and little else. The list of
services not covered by medicare is long: out-of-hospital drugs, nursing, psychology and other
counselling, community mental health services, nutrition advice, ambulance services, addiction
treatment, long-term care, eye care and dental care.
The health care system is only part of the picture
We also need to get past our myopic focus on health care to a broader view of health more
generally. Health is much more than patching up people once something has gone wrong.
The Senate Subcommittee on Population Health 14 estimated that only 25 per cent of the
population’s health outcomes can be attributed to the health care system on which we lavish
such attention. Half can be explained by socio-economic factors such as education and
income; another 15 per cent relates to biology and genetics, while the physical environment
accounts for the remaining 10 per cent. To bring about meaningful reform, we must bring all
these environmental factors into the equation. For example, strategic education interventions
may be more effective in reducing future health care costs than investments in hospitals today.
Yet amazingly, three-quarters of the influences that account for health outcomes barely
register in the health care debate.
The system does not produce superior results
Canadians consistently tell pollsters that they do not particularly care much about the cost of
health care — they simply want access and quality of care. The high cost of our health care
system could perhaps be forgiven if the spending produced superior results. It does not.
Canada does not appear in a favourable light on a value-for-money basis relative to other
countries. A 2010 report by the Commonwealth Fund 15 ranked the quality of the health care
systems in Australia, Canada, Germany, the Netherlands, New Zealand, Britain and the
United States. Predictably, the United States came last. But Canada was second to last in
the overall ranking, second to last on efficiency and dead last on the timeliness of care.
14 Standing Senate Committee on Social Affairs, Science and Technology, Final Report of Senate Subcommittee on Population Health,
“A Healthy, Productive Canada: A Determinant of Health Approach,” June 2009, pp. 7–9, downloaded from
http://www.parl.gc.ca/Content/SEN/Committee/402/popu/rep/rephealth1jun09-e.pdf.
15 Commonwealth Fund, “Mirror, Mirror on the Wall: How the Performance of the U.S. Health Care System Compares Internationally, 2010
Update,” p. 3, downloaded from http://www.commonwealthfund.org/~/media/Files/Publications/Fund%20Report/2010/
Jun/1400_Davis_Mirror_Mirror_on_the_wall_2010.pdf.
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