Evaluating claims about the system

Evaluating the accuracy of claims about the system is hampered by several factors. The highly decentralized nature of health care delivery means that good data is not always available. It is often difficult to distinguish compelling but atypical anecdotes from systemic problems. Considerable effort is being made to develop and implement comparable indicators to allow better assessment of progress. However, the Health Council of Canada - with a mandate to monitor and report on health reform - complained in 2007 that progress has stalled
The debate about health care has also become heavily ideological. The Fraser Institute, a think tank supporting "competitive market solutions for public policy problems" is a frequent critic of medicare. It publishes yearly reports about wait times which are then used to argue that the system is both failing and unsustainable. Others criticize their methodology, which is based on physician perceptions rather than actual waits. Other complaints come from the political left, who object to 'privatization' (by which they usually mean a heavier involvement of for-profit providers). (See, for example, the Canadian Health Coalition web page. There are frequent debates in the media and on line between advocates and opponents of Canadian healthcare.
Wait times and access
Common complaints relate to access, usually to elective surgery (especially hip and knee replacement and cataract surgery) and diagnostic imaging. These have been the primary targets of health care reinvestment, and it appears that considerable progress has been made for certain services, although the implications for procedures not on the target list are unclear. Canadian physicians have been heavily involved, particularly in developing appropriateness criteria to ensure timely access for necessary care. It is estimated to have cost Canada's economy $14.8 billion in 2007 to have patients waiting longer than needed for medical procedures.
Health human resources
A related issue is the volume, and distribution, of health human resources. There are ongoing issues about the distribution of physicians, with the pendulum swinging from arguing that there were too many, to arguing that there were too few. As Ben Chan found, the major factor driving the drop in physician numbers was changes in training programs. Combined with such factors as changes in the hours worked by each physician , and a decrease in the proportion of doctors choosing to go into family practice, there were shortages in some areas, particularly for general practitioners (GP) / family doctors. One response has been to encourage 'primary care reform', including greater use of multidisciplinary health care teams. There are also ongoing issues regarding nurses. (See Nursing Health Services Research Unit, which links to some reports. CIHI also gives data about nursing.