Without having looked at those “quality” measures in any great detail, I can say that most composite quality measures for health care combine weighted averages of apples, oranges, cows, and cars to come up with a totally meaningless number.
From the societal level, you end up looking at the health of the population, which depends not only on health care but also on income levels, education, clean water, sanitation, etc., etc. Across the world, the public health things vary a lot, so things like differences in sanitation matter more than access to doctors (this is why you can’t directly compare Cameroon to Canada). Within populations in first world countries, we’ve mostly fixed the public health problems, so income is the thing that makes the biggest difference, with the top quintile have far better health outcomes than the lowest quintile.
So, for the entire population, you can look at things like life span, rates of disease, etc., but the differences you see may have nothing to do with health care, OR they might reflect too much access to health care (or the wrong sorts of health care). An excess of ICU beds may be the result of greater levels of critical illness, or inadequate access to good care in “normal” beds. One way or the other, those ICU beds will be filled, and somebody will be making the case that more are needed. Generous access to health care translates to excess diagnoses (over-diagnosis), which don’t improve health in terms of lifespan, etc., but do mean more people are in hospital beds, on meds, having surgeries, taking prescribed drugs, etc.
Looked at the other way round, what matters to the individual is something like “timely access to effective care when I need it, which is when I’m sick”. By that measure, the Canadian system isn’t doing very well. 15% of the population have no family doctor. After that, just about every report you see highlights our horrendously long wait times for diagnostic testing, specialist consultations, surgeries, etc. Emergency departments (when they are open) are over-crowded, with long waits and ambulances lined up outside. Admitted patients line up in emergency, for lack of access to inpatient beds. Patients discharged to nursing homes linger in hospitals, for lack of nursing home beds. Those who need home care stay in hospital longer, waiting for home care to become available. There are even line-ups for preventative care, like flu shots, these days! The care you get, when you eventually get it, is generally of reasonable quality, but there are far too many delays with their associated inefficiencies.
The lack of timely access does show an effect in the high level measurements, like expected lifespan, but the effect is diluted and delayed. Even so, the various delays in our system have increased post Covid, and the expected lifespan at birth has dropped, for the first time in decades, not so much because of Covid-related deaths (which mostly happen in the very elderly), but more because of the knock-on effects on our health care system (lots of surgeries, testing, preventative care, etc. cancelled or deferred during the pandemic).
All of which is to say that I think you need to look at quality measures that emphasize timely access to care, things like wait times for hip and knee surgery, etc. (bearing in mind you wait months to see an orthopedic surgeon before you even get on the wait list for the surgery). I think you would find that our relatively expensive system performs very poorly on access, and hence quality, and hence the cost-effectiveness is poor.
Oh, I’d love a mere 97-day wait for replacement surgery. My ‘expedited’ hip replacement took eight months. My wife has just been added to the waiting list for a new knee - one year . . .
Without having looked at those “quality” measures in any great detail, I can say that most composite quality measures for health care combine weighted averages of apples, oranges, cows, and cars to come up with a totally meaningless number.
From the societal level, you end up looking at the health of the population, which depends not only on health care but also on income levels, education, clean water, sanitation, etc., etc. Across the world, the public health things vary a lot, so things like differences in sanitation matter more than access to doctors (this is why you can’t directly compare Cameroon to Canada). Within populations in first world countries, we’ve mostly fixed the public health problems, so income is the thing that makes the biggest difference, with the top quintile have far better health outcomes than the lowest quintile.
So, for the entire population, you can look at things like life span, rates of disease, etc., but the differences you see may have nothing to do with health care, OR they might reflect too much access to health care (or the wrong sorts of health care). An excess of ICU beds may be the result of greater levels of critical illness, or inadequate access to good care in “normal” beds. One way or the other, those ICU beds will be filled, and somebody will be making the case that more are needed. Generous access to health care translates to excess diagnoses (over-diagnosis), which don’t improve health in terms of lifespan, etc., but do mean more people are in hospital beds, on meds, having surgeries, taking prescribed drugs, etc.
Looked at the other way round, what matters to the individual is something like “timely access to effective care when I need it, which is when I’m sick”. By that measure, the Canadian system isn’t doing very well. 15% of the population have no family doctor. After that, just about every report you see highlights our horrendously long wait times for diagnostic testing, specialist consultations, surgeries, etc. Emergency departments (when they are open) are over-crowded, with long waits and ambulances lined up outside. Admitted patients line up in emergency, for lack of access to inpatient beds. Patients discharged to nursing homes linger in hospitals, for lack of nursing home beds. Those who need home care stay in hospital longer, waiting for home care to become available. There are even line-ups for preventative care, like flu shots, these days! The care you get, when you eventually get it, is generally of reasonable quality, but there are far too many delays with their associated inefficiencies.
The lack of timely access does show an effect in the high level measurements, like expected lifespan, but the effect is diluted and delayed. Even so, the various delays in our system have increased post Covid, and the expected lifespan at birth has dropped, for the first time in decades, not so much because of Covid-related deaths (which mostly happen in the very elderly), but more because of the knock-on effects on our health care system (lots of surgeries, testing, preventative care, etc. cancelled or deferred during the pandemic).
All of which is to say that I think you need to look at quality measures that emphasize timely access to care, things like wait times for hip and knee surgery, etc. (bearing in mind you wait months to see an orthopedic surgeon before you even get on the wait list for the surgery). I think you would find that our relatively expensive system performs very poorly on access, and hence quality, and hence the cost-effectiveness is poor.
Oh, I’d love a mere 97-day wait for replacement surgery. My ‘expedited’ hip replacement took eight months. My wife has just been added to the waiting list for a new knee - one year . . .
Yes. Cost effectiveness. Listen to the doctors and nurses. In Quebec they complain the system is too top-heavy.