How to improve Canadian health care?

In Canada, health care costs the public sector about $ 160 billion a year, a higher per capita cost than most industrialized countries. Yet Canadians are not particularly healthy and do not receive better care.

 The Commonwealth Fund has ranked Canada tenth among eleven developed countries for the efficiency of its health system (only the United States is worse than us). We are at the bottom of the list with respect to access to care, speed of care and overall quality of care, and for none of the measures reviewed we ranked in the top three .
Maybe our health system is not as good as we like to believe. How can we improve Canadian health care to catch up with the pack?
One factor that works against us is how public health spending is distributed. For example, the way we spend money on health is often process-driven rather than results-based. Most provincial governments pay health care providers on a fee-for-service basis, at least in part, rather than on health outcomes. Doctors are often paid , at least in part, by the number of patients they see or the actions they take without much regard to the quality or appropriateness of the care provided.
A system that promotes improved quality and access to care, offers the best possible return on health budgets, and rewards innovation may be the answer.
The goals sought by patients, a good care experience and a sustainable quality of life, could be measures of success. Financial incentives that reward healthcare providers for maintaining good health for their patients would encourage innovation in important areas of health that historically have been difficult to implement, such as health promotion and management. prevention of the disease.

How could we achieve this?

Governments can not impose innovation, but they have some leverage to encourage those who want to experiment and innovate. Establishing an innovative national vision to drive change would send a powerful signal that the status quo is not in the best interest of Canadians.

Governments can not impose innovation, but they have some leverage to encourage those who want to experiment and innovate.

Interesting financial experiments have already been conducted in Canada.

In Mississauga, hospital care providers Trillium Health Partners and Saint Elizabeth home care have agreed to be jointly paid by the province based on the health status of patients with heart disease as they leave the hospital. Linking their funding has encouraged both organizations to work more closely together and to ensure that patients experience a seamless transition between care while reducing associated costs. After one year, the results are promising. Patients are discharged earlier and postoperative readmissions to hospitals and emergency departments are declining.

New Brunswick is implementing new approaches to provide better health care to the community. Medavie Health Services, a private provider of medical and emergency health care services, will soon enter into a performance-based contract with the province. The reimbursement will be related to measures related to increasing the system capacity and improving the patient experience and health outcomes of the population.

Meanwhile, the federal government recently unveiled the first social impact bond to promote health in Canada by supporting a blood pressure control program led by the Heart and Stroke Foundation, in collaboration with the Canadian Stroke Foundation. MaRS Impact Investment Center. The payments the Federal Heart and Stroke Foundation will receive will vary in terms of controlling participants’ blood pressure.

These experiences are important first steps, but the ambition must be much greater in order to be able to make a real change.

Canada needs a national strategy for measuring results and health financing, in partnership with the provinces and territories, and a great willingness to test new approaches and adopt those that work. Federal support and evidence-gathering unit could provide expertise in funding innovation for provinces and health care providers seeking to test new payment approaches and allow others to learn from those who have already done so in Canada and abroad.

We need to change our focus to achieve better health outcomes and better returns on spending in this area. To do this, governments and health care providers must intentionally and strategically test payment options that encourage health care providers to seek higher quality and value. The future of health care depends on it.

Improve and measure the quality of health care


This publication presents new data on patient safety in OECD countries and shows that large variations in quality of care remain for cancer, stroke, heart attack and services provided by physicians in the OECD. family. The paper discusses ways in which countries can improve quality measurement, the balance between privacy and transparency in terms of quality and safety, and the links between quality indicators and policy to improve the performance of countries. doctors, hospitals and the health system as a whole.


Health care systems face increasing challenges: increasingly complex care, rising demand for health care (especially for chronic diseases) and an economic context where the supply of services must increase at lower cost. Measuring the quality of health care becomes a key issue. Poor quality of care undermines the goals of modern systems and harms the health status of the population and even increases mortality rates. In addition, this deficient quality wastes health care resources, an unacceptable situation at all times, but even more so when financial resources are scarce. The OECD Health Care Quality Indicators (HCQI) Project has been developing since 2002 a conceptual and methodological framework on the quality of care.

Analysis / results

It is becoming increasingly evident in many countries that health care is offered without consideration of scientific principles and good professional practice. The result is a lower quality of care and negative effects for tens of thousands of people. However, many countries are improving the quality of their health services, and this progress is largely based on measuring quality.

Measuring, evaluating and comparing quality of care are three essential elements of health system governance that seeks to improve quality. Ultimately, the goal is to provide safe, effective and responsive care for patients.

Quality indicators developed by the OECD HCQI Project show the variability in quality of care across OECD countries:

  • Available data for asthma, chronic obstructive pulmonary disease, diabetes and heart disease show the importance of an effective primary care system.
  • Data on heart attacks and strokes show a large overall improvement in the quality of care, but some countries still show very poor performance.
  • Hospital readmission data for schizophrenia and bipolar disorder cases, which vary widely across countries, raise questions about the quality of mental health care.
  • Data from patient safety indicators raises questions about reporting incidents (for example, accidental lacerations or trauma in obstetrics) and improving safety policy.

Survival and mortality data from cancer show improvements in care, but there is wide variation from one country to another.


This report describes why information about the quality of health care is important and how it can be used. It presents examples from several countries that illustrate how quality improvement initiatives can be implemented in various care systems. Despite these examples, there is still a lot of work to be done and improved care needs to be adapted to each context. However, the various experiences reported in several countries by the experts make it possible to draw similar conclusions.

Consequences, recommendations

Recommendations for Quality Measurement Indicators for Health Care

Access to Data:

  • develop a legislative framework that balances data protection and confidentiality with the need for valid and accessible information to support good governance;
  • exploit the potential of national databases and registers to measure the quality of care;
  • implement the use of computerized health records;
  • establish national systems for collecting longitudinal data on patient experience.

Recommendations for the application of health care quality indicators

  • Ensure that common indicators are used to account for all improvements in the quality of care.
  • Ensure consistency and alignment of quality measurement efforts with the national quality of care policy.
  • Look for examples of quality improvement in other countries’ practices and determine how they can be applied locally.