Do you get good health care for your tax dollars?

According to a recent study, this year the average Canadian family of four will spend $21,115 of their total tax bill on Canada’s public health-care system. This bill is neither necessarily a good thing nor a bad thing. Like the purchase of any other good or service, the cost is only half the equation. The other half is what that money purchased.

Do Canadians get good value for that price tag?

Let’s first put that number into perspective. In 2023, the latest year of available comparable data (including both tax-funded and private health-care spending), among 31 developed countries with universal health care, only New Zealand and Switzerland spent slightly more (as a share of their economy) on health care than Canada. The average country spent 21 per cent less than we did.

And what did Canadians get for this world-class level of spending?

Not a lot, actually. Despite ranking near the top in health-care spending, Canada ranked close to the bottom in the numbers of doctors, hospital beds and medical technologies per person. And despite spending 21 per cent less than Canada, the average universal country had 46 per cent more doctors, 73 per cent more hospital beds, 87 per cent more MRI machines, and 105 per cent more CT scanners.

Perhaps unsurprisingly, given the relative lack of health-care resources, Canadian wait times for health care also ranked among the longest in the developed world whether for primary care, specialist consultations or non-emergency treatment.

This is neither a new development nor a post-COVID phenomenon. Canada has a long history of expensive mediocrity when it comes to the availability of health care. Other developed countries have long done a far better job of turning health-care dollars into health care for patients than Canada’s provincial and federal governments.

This depressing story is important to keep in mind when assessing health-care reform proposals. The provinces and the federal government grapple with this same reality—sub-par access for a premium price. We should judge every health policy reform proposal from the perspective of how it addresses or fails to address this central problem, rather than against an idealized vision of health care that simply doesn’t exist.

While Canadians spend a large portion of their total tax bill to fund their health-care system, it’s difficult to argue they get good value for their health-care dollars. That’s an important reality to keep in mind whenever policymakers discuss health-care reform.