Quebec tops Fraser Institute’s healthcare rankings, while Newfoundland is last

The Vancouver-based Fraser Institute has issued another health-care report card that's bound to create controversy.

The free enterprise-oriented think tank released its 2013 Provincial HealthCare Index on Tuesday.

It concludes Quebec and Ontario residents get the best value for money from their public healthcare system. But if you live in Newfoundland and Labrador or in Prince Edward Island or Saskatchewan, you're not getting great bang for your medical buck, according to the Fraser Institute.

It's probably simplistic to distill the many parameters the new study uses to measure a healthcare system's effectiveness down to a single number out of 10. But the institute's ranking stacks up like this:

Quebec 10, Ontario 7.43, New Brunswick 5.87, Nova Scotia 4.73, B.C. 4.12, Manitoba 3.66, Alberta 3.35, Saskatchewan 1.17, P.E.I. 0.48 and NL 0. Yes, zero.

[Related: Fraser Institute says healthcare insurance costs Canadian families over $11k a year]

The study used data from 2010, the most recent year available, to measure the provision of healthcare in comparison to expenditures, the report's executive summary says. It looked at 46 indicators pulled into four groups: Availability of resources; use of resources; access to resources and clinical performance of medical goods and services.

"The data indicate that, when compared to other provinces, residents of Quebec receive the best value (provision of healthcare) for money (expenditure on healthcare) from their public healthcare system, followed by residents of Ontario and New Brunswick," the report says.

"Conversely, those living in Newfoundland & Labrador receive the least value for money from their public healthcare system, followed by residents of Prince Edward Island and Saskatchewan."

The National Post noted the institute acknowledges it did not try to link its results to specific government policies. And a healthcare economist observed the study also doesn't factor in demographic differences and other local characteristics that could affect performance.

Livio DiMatteo of Lakehead University in Thunder Bay, Ont., called the review a valuable exercise but said it fails to consider things like age and the the economies of scale available to larger provinces like Quebec and Ontario. He also questioned how the report weighs the four healthcare attributes in the final ranking.

“Having better access and availability, but poorer clinical outcomes, might not necessarily be the best value for money,” he told the Post.

But Nadeem Esmail, the institute's health-policy director, said the comparisons nevertheless help keep provinces accountable for their administration of healthcare.

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“This study allows policy-makers and taxpayers to judge whether they’re receiving good value,” he told the Post.

“On a national basis, Canada’s health-care system provides very poor value for money, but within Canada there are clearly some provinces that are doing better than others.”

When the Canadian healthcare system as a whole is weighed against those of other developed countries, it fares poorly, he said.