菲沙研究所-2021年全民医疗保健国家绩效比较（英）-2021.11-66页_1mb

Summary of "Comparing Performance of Universal Health Care Countries, 2021"

Core Content

This report compares the performance of Canada's health-care system with 28 other high-income OECD countries with universal health care, using a "value for money" approach. It evaluates both the cost and the performance of these systems through a range of indicators.

Main Objectives

• To assess how much Canada spends on health care relative to other countries.
• To evaluate the performance of Canada's health-care system using four broad categories: availability of resources, use of resources, access to resources, and clinical performance and quality.
• To provide Canadians with insights into whether the value received from their health-care system is proportional to the cost.

Key Findings

1. Health Care Expenditure

• Canada spends more on health care than most high-income OECD countries with universal health-care systems.
• As a percentage of GDP, Canada ranks 2nd highest out of 28 countries after age adjustment.
• Per capita spending, Canada ranks 8th highest after age adjustment.
• The report uses two indicators to measure health care expenditure:
  • Total health care expenditure as a percentage of GDP
  • Total health care expenditure per capita (adjusted for purchasing power parity)

2. Availability of Resources

• Canada has fewer physicians, acute-care beds, and psychiatric beds per capita compared to the average OECD country.
• It ranks 8th for long-term care beds (per 1,000 over 65).
• Canada has third most Gamma cameras (per million population), but fewer MRI, CT, and PET scanners than the average high-income OECD country.
• The availability of resources is an essential component of a functioning health-care system, but Canada lags behind many peers in this area.

3. Use of Resources

• Canada's performance in terms of use of resources is mixed.
• It performs better than the average OECD country on under half the indicators examined, such as cataract surgery and knee replacement.
• It performs average to lower on the rest of the indicators.
• Canada reports the least degree of hospital activity in the group, as measured by curative-care discharges.

4. Access to Resources

• Canada ranked last (or close to last) on four of four indicators measuring timeliness of care.
• It ranked 7th out of 10 on the indicator measuring the percentage of patients who reported cost as a barrier to access.
• Access to timely and affordable care is a critical factor in evaluating health-care system performance.

5. Quality and Clinical Performance

• Canada performs well on five indicators of clinical performance and quality, including survival rates for breast, colon, and rectal cancers.
• However, its performance on seven other indicators is either no different from the average or worse, such as for diabetes-related amputations and obstetric trauma.
• The report emphasizes the importance of including clinical performance and quality in the evaluation of health-care systems.

6. Health Status and Outcomes

• Five indicators of health status are included in the report, such as life expectancy, infant mortality rate, and healthy life expectancy (HALE).
• These indicators are influenced by non-medical determinants of health, such as lifestyle, environment, and genetics, which lie outside the scope of the health-care system itself.

Methodology

• The study uses a value for money approach, comparing cost and performance.
• Indicators are categorized into four main groups:
  • Spending: 2 indicators
  • Availability of resources: 10 indicators
  • Use of resources: 10 indicators
  • Access to resources: 5 indicators
  • Quality and clinical performance: 12 indicators
  • Health status: 5 indicators
• Age adjustment is applied to expenditure, availability, and use of resources to account for demographic differences.
• The report includes both unadjusted and age-adjusted rankings for a more comprehensive analysis.
• Data sources include the OECD, Commonwealth Fund, and WHO, with data from 2019 and 2020 used for comparison.

Conclusion

• Despite Canada's relatively high health-care expenditure, its performance is modest to poor in terms of resource availability and access.
• The system's performance in terms of resource use and clinical outcomes is mixed.
• The report suggests that there is an imbalance between the value received and the cost incurred in Canada's health-care system compared to its international peers.
• The findings highlight the need for a more nuanced understanding of how health-care systems perform and the importance of considering both cost and outcomes when evaluating their value.

Key Countries Compared

• The 28 countries included are members of the OECD, have universal or near-universal coverage for core medical services, and are classified as high-income by the World Bank.
• The countries include: Australia, Austria, Belgium, Canada, Czech Republic, Denmark, Finland, France, Germany, Greece, Iceland, Ireland, Israel, Italy, Japan, Korea, Latvia, Lithuania, Luxembourg, Netherlands, New Zealand, Norway, Portugal, Slovenia, Spain, Sweden, Switzerland, United Kingdom.

Additional Notes

• Some indicators were updated or replaced due to new data availability.
• Age adjustment is applied to ensure fair comparisons, especially for expenditure and resource use.
• The report acknowledges that non-medical factors can significantly impact health status, and thus should be considered when interpreting the results.