Discussions of healthcare reform must acknowledge the following context: on the one hand, public opinion data suggest that Canadians are increasingly concerned about the future viability of public healthcare; on the other hand, Canadians remain highly supportive of universal healthcare in principle, and they remain largely pleased with their own interactions with the system.
There has been a striking increase in public spending on healthcare over the last 10-15 years. Specifically, controlling for inflation, per capita spending on healthcare in Canada was more than 50% higher in 2010 than in 1996.
This investment in healthcare has positive consequences where public assessments are concerned. Increased healthcare expenditures over the past decade appear to have made a difference: Canadians’ assessments of the current system have improved alongside increased expenditures.
Cross-provincial differences in the relationship between various measures of healthcare policy outcomes provide a valuable source of evidence on “value” in healthcare, and results confirm that value is not simply about spending more. For instance, the relationship between spending on physicians and the number of doctors per capita or wait times, or between hospital spending and the nursing workforce, clearly varies across provinces. In some cases increased spending appears to lead to better health policy outcomes; in other cases the relationship is much less clear.
The relationship between increased spending and improved public assessments also appears to vary across spending domains. Specifically, investments in hospitals, in drugs and in public health are more reliably linked to improved public assessments of the system, while spending in other healthcare domains is not clearly associated with improved public assessments.
Capturing “value” in healthcare is possible, then. But at present the required data – including data on key healthcare indicators and public attitudes on healthcare – are only intermittently available. A stronger commitment to monitor system outcomes should accompany a renewed investment in the Canadian healthcare system.