Complacent with comparisons

The Canadian Institute for Health Information presented its year end tally of health spending in Canada and, no surprise, it's up again. $121.4 billion for the year 2003, or $3,839 per person, or 10% of GDP, which places us 4th of 12 comparative OECD countries in health spending as a percentage of GDP behind the US, Switzerland and Germany. We're okay with that. Health is the #1 priority among Canadians and there's a common desperation for improvement. So we spend, we create an accountability body to monitor performance -- we don't mind spending as long as we get our money's worth.

Our fetish for measuring performance was fueled in the crucial three years we've just lived through by the WHO report of 2000 which ranked health system performance in 191 countries. We came 30th. Hard to believe for anyone who's ever been outside Canada, the figure was widely cited by influential Canadians as a sign that we had serious problems. In December 2003, Prof. Raisa Deber from the University of Toronto published a critique of the WHO report (see Longwoods Review Vol.2, No.1), piercing enough holes in the methodology that she could confidently conclude the ranking had no relevance to "access, utility, quality, cost-effectiveness, or most other dimensions of health systems." Now we can only wonder how many of the steps we've taken since 2000 were based on faulty use of a faulty ranking.

Susan Usher