| Safe | Avoiding injuries to patients from the care that is intended to help them. |
Although there is ample evidence that Canadians suffer preventable harm owing to unsafe care,52,53 useful international comparisons focusing on the safety of health care are rare. According to OECD, Canadians undergoing hip or knee replacement are nearly twice as likely to develop a postoperative pulmonary embolism than individuals in a range of comparator countries, and Canadians undergoing abdominal surgery are 37% more likely to develop postoperative sepsis.54 However, it is not clear that these comparisons reflect genuine differences; OECD cautions in its report that “higher adverse event rates may signal more developed patient safety monitoring systems and a stronger patient safety culture rather than worse care.”54
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| Timely | Reducing waits and sometimes harmful delays for both those who receive and those who give care. |
Canadians wait longer for nonemergent care than people in many other high-income countries.55 A recent Commonwealth Fund survey found that 25% of Canadians reported waiting longer than 8 weeks to see a specialist, compared with just 3% in Switzerland and the United States, and between 10% and 20% in most other high-income countries.56 With respect to primary care, another Commonwealth Fund survey found that only 53% of Canadian family physicians reported that their patients were able to receive an appointment on the day they asked for one, or the next day, compared with 72% of counterparts across a range of similarly high-income countries.56
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| Effective | Providing services based on scientific knowledge to all who could benefit, and refraining from providing services to those not likely to benefit (avoiding underuse and overuse, respectively). |
International comparisons suggest that Canadians have good health outcomes for many health conditions. For example, Canadians diagnosed with cancer can expect five-year survival rates that are as good as or better than those in most other countries.57 Similarly, on measures of “avoidable mortality” (i.e., mortality from conditions for which there is effective health care), Canada performs well in comparison with other countries.58 Nevertheless, there are still many examples of both underuse and overuse in Canada that highlight opportunities for improvement. For example, less than 1% of public drug plan beneficiaries in Ontario receive first-line, evidence-based medications for alcohol use disorder in the year following this diagnosis.59 With respect to overuse, unnecessary testing is a classic example, with preoperative electrocardiography before low-risk surgery ranging from 3.4% to 88.8% across different hospitals in one study.60
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| Efficient | Avoiding waste, including waste of equipment, supplies, ideas and energy. |
The amount of money Canada spends on health care, on a per capita basis, is similar to that in other high-income countries.61 Looking beyond aggregate expenditure, Canada has fewer hospital beds and physicians62 for its population size than similar high-income countries, suggesting that physician and hospital care in Canada are reasonably efficient.7 However, Canada may seem less efficient on other comparisons; for example, we pay more for prescription drugs63 than in most other high-income countries.
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| Equitable | Providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status. |
The Canada Health Act was designed to ensure that Canadians are treated by physicians and in hospitals without charge. Despite the removal of this financial barrier, many studies have shown that poorer Canadians are less likely than richer Canadians to receive evidence-based preventive health care.64 Poorer Canadians also have worse health outcomes than more wealthy Canadians.64 Similarly, Canadians who live outside large urban centres appear to receive lower-quality care and often have worse health outcomes.65 This problem is particularly severe for Indigenous Canadians. In areas not covered by the Canada Health Act, such as home care and outpatient prescription drugs, financial barriers are common. For example, about 1 in 4 Canadians without prescription drug insurance do not take their medications as prescribed because of the cost, compared with about 1 in 15 Canadians who do have this insurance.66 The most recent Commonwealth Fund survey showed that 9% of older Canadians have problems getting care because of cost. This compares favourably to both the United States (23%) and Australia (13%), but unfavourably to Sweden (3%), Norway (4%) and the United Kingdom (4%).67
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| Patient-centred | Providing care that is respectful of and responsive to individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions. |
Commonwealth Fund surveys show that Canadians tend to report good experiences with their physicians compared with individuals living in other high-income countries.68 However, there are areas in which patient-centredness could be improved in Canada. For example, many hospitals allow visitors only at certain times,69 and many patients report that they do not receive care in a culturally sensitive way.70
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