The biggest hindrance to better health care is our own illusions.

Contrary to public opinion, Canada does not have the best health-care system in the world. We actually rank 26th, but have the fifth highest health-care expenditures. So, which countries fare better than us, and why?

The Canadian Medical Association recently found that 17 of the world’s top 20 national health-care systems are European. These world leaders all have mixed systems that combine both public and private providers so everyone is covered. No one has huge medical bills and information technology is widely used.

Using central IT databases to input prescriptions has led to less drug abuse, greater oversight and increased transparency. Also, the efficient integration of public and private services has actually drawn on the strengths of both systems so patients can access the care they need without expensive bills. Countries have even been able to expand coverage to include global prescription drug coverage. The introduction of healthy competition has spurred innovation, better care and cancelled out inefficiencies in the health system.

In Europe, patients are placed at the centre of the health-care system. Hospitals are motivated to attract patients and provide optimal care because they receive funding and resources for services rendered instead of block-funding. Money is then freed up for prevention, health promotion and other initiatives that reduce the demands on the system.

When Europeans hear that Canadians tolerate atrocious waiting lists of nine to 12 months or more for care they are shocked. Unfortunately, the debate around health-care reform in Canada remains mired in the false assumption that changes to our current system would result in a U.S.-style system. Policy-makers have chosen to look the other way rather than act, and as a result Canadians are suffering a decline in access to care.

Canadians must fully grasp the following truths:

• An aging population and more expensive technologies are exhausting the supply of government money for health care. This structural shortfall will be exacerbated by the global economic downturn.

• The Canada Health Act, and its five principles (public administration, comprehensiveness, universality, portability and accessibility), is broken in every province, every day.

We actually have a mixed system, but it is not integrated in a way that supports our public system. As such, the status quo is contributing to the creeping privatization of our public system.

If we fail to modernize our health-care system and live with the illusion that we have the best system, more and more people, particularly those of modest means, will fail to receive the care they need. We can have the best health-care system in the world, but we must have courage and not fear change.

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