Canada scores low in patient safety

Canada fares well compared with other OECD countries for low smoking rates, but has some of the worst patient safety incidents such as leaving in foreign bodies during surgery, according to a new report.

Wednesday's report by the Canadian Institute for Health Information is called "Learning From the Best: Benchmarking Canada's Health System," and looks at the latest statistics and indicators comparing health systems on quality of care and access to care. 

Canada reported some of the highest rates among 17 reporting countries of accidental puncture or laceration, as well as of foreign bodies left in during surgical procedures. It also had among the highest rates of obstetrical trauma.

"I think that's something that definitely warrants more investigation," said Kathleen Morris, director of health system analysis and emerging issues at CIHI. "Is it that we're more honest about reporting that data? Or are our rates really higher? What can we learn about what's done in other countries?"

There are techniques to improve patient safety, such as counting instruments and sponges after surgery and training on a dummy or doing computer simulations before surgery that could help, Morris said.

Access to care

Wait times were highest in Canada in an 11-country survey cited in the OECD report. Nearly 60 per cent of respondents said  they had to wait four weeks or more to see a specialist and 25 per cent said they waited four months or more for elective surgery.

In terms of five-year survival rates for cancer, Canada was close to the OECD average for cervical cancer, above average for colorectal cancer, and behind the U.S. and Japan for breast cancer.

But cancer deaths remained relatively high in Canada, particularly for cancers that are hard to screen for and treat early, such as lung cancer.

Obesity still a problem

Canada is among five OECD countries that have decreased their smoking rates by more than 30 per cent since 1999. It is virtually tied with the U.S. for the lowest rate of adult smokers among G7 countries at 16.2 per cent, compared with 16.1 per cent in the U.S.

Lower smoking rates may mean fewer lung cancer cases in the future, but the progress could also be offset by higher obesity rates that are also a risk factor for cancer, said Morris. 

Actual measurements of height and weight suggest Canada’s obesity rate is 24.2 per cent, which is less than the U.S. rate of 33.8 per cent. In the UK, it is 23 per cent.

More than a quarter of Canadian boys and girls are overweight. Canada is one of only three G7 countries (along with Italy and the U.S.) where the prevalence of overweight is above 25 per cent for both groups.

In contrast, for measures of quality of care, such as hospital admissions for chronic conditions that can often be avoided through good primary and community care, Canada's results were better than the OECD average.

These include hospital admissions for diabetes and asthma, post-operative complications, such as sepsis, and coverage of cancer screening and influenza vaccinations.

The OECD report said Canada spent 11.4 per cent of its gross domestic product on health in 2009, more than the OECD average of 9.6 per cent.

The United States spent the most, at 17.4 per cent of GDP, with the Netherlands, France and Germany spending slightly more than Canada.

"What we did see though is even within our system, where access to most health care is at no cost to the patient, that lower- income Canadians were less likely than those in other countries to access health care," Morris noted. "Could be that it's complicated for low-income Canadians to take time off work or to find child care to see a physician?"