Comment / Exchange rate

HFMA chief executive Mark Knight returns from a exchange trip to Canada and the US with confidence that the UK health system is on the right path.

As I landed at Toronto airport to attend the 28th UK/US Exchange, I was given a clear reminder that we were in Canada, not the US. 

Despite having plenty of notice of our arrival, there were just three border patrols on duty and literally hundreds of people lined up to get in. 

The contrast with arriving in the US was stark: when the queue (or the line in North America speak) becomes too great, other booths open up.

It served as a small reminder to me to be ready for a different experience.

As the programme went on, it became clear just how well the UK health system compares on the international stage and how far the NHS has come in the past few years. Even if we just focus on comparisons with England, it is quite clear that the model in Ontario is similar to the system in the UK during the 1990s with a type of block grant allocation and little evidence of any real payment system.

There is a strange quirk in the allocation system where when one Canadian moves from one area to another they take their allocation with them. There was no evidence, however, of anything approaching the sophistication of the market forces factor, despite major differences in regional prices (for instance, the oil-rich province of Alberta exhibits prices far higher than average).

To be fair to the Canadians, their health delivery does have some strong features. It is a universal system, like our own, and St Michael’s hospital in Toronto demonstrated that the care it provides is of a high standard. Canada suffers from the same problem Australia does – rurality on a major scale – and this is bound to increase cost. 

We also had a briefing on the way the Canadian system works, which again seems to mirror the Australian approach.  It also has a federal system and the inevitable tensions of ‘postcode’ problems exist as different states tend to choose different priorities. 

As well as 10 provinces there are three territories in Canada that are remote areas. Here the Canadians have very poor outcomes and so this remains a focus of particular attention for the government. 

The killer blow to any North American hopes of claiming to be the best in healthcare was the final presentation from Dr Karen Davis, president of the Commonwealth Fund, which sponsors healthcare research. 

She talked about the independent organisation’s ‘Mirror, mirror’ survey. This revealed that, on average, overall the UK ranked first out of a list of six countries, including  Canada, USA, New Zealand, Germany and Australia.  On most indicators the USA was placed sixth and Canada fifth, while UK scored highly for efficiency and equity.

This report is available at www.commonwealthfund.org and for those of you who feel you’re not getting anywhere: think again. We may not be at the place where we want to be yet in the UK, but pound for pound our system is recognised as a fantastic achievement.

Finance people help to make that happen and this sent UK delegates off with a spring in their step!  Keep up the good work.