Photo Credit: globeandmail.com
In spite of Canadians’ constant complaints about our hospitals – the long wait times and the lack of service – four of our hospitals are ranked highly by Newsweek’s Best Hospitals 2020. In fact, three Canadian hospitals are on the top 30 list and one is between 51 and 100. Toronto General Hospital enjoys the position of the fourth highest-ranked hospital, even above the world-renowned Johns Hopkins Hospital in Baltimore, Maryland. Part of the University Health Network, Toronto General has only 727 hospital beds – the smallest of the top five – but is positioned just behind the Mayo Clinic in Rochester; the Cleveland Clinic in Cleveland; and the Massachusetts General Hospital in Boston. Sunnybrook Health Sciences Centre is ranked number 24 while Mount Sinai Hospital is number 29, way ahead of Stanford Health Care of Stanford Hospital and the New York Presbyterian Hospital – Columbia and Cornell, and the Ronald Regan UCLA Medical Center. North York General Hospital is ranked within the top 100, but was only listed alphabetically as it’s between number 51-100.
This was the second year in a row that Newsweek partnered with global data research company Statista Inc. to rank the leading hospitals in 21 countries. The publication also involved a panel of global experts, an independent body of medical experts that is tasked with the oversight and continuous developnemt of the quality and scope of the project.
The World’s Best Hospitals 2020 ranking lists the best hospitals in 20 countries and one city-state: the United States, Canada, Germany, France, United Kingdom, Italy, Spain, Switzerland, the Netherlands, Sweden, Denmark, Norway, Finland, Israel, South Korea, Japan, Singapore, India, Thailand, Australia, and Brazil. The rankings are based on recommendations from medical professionals, results from patient surveys, and key medical performance indicators.
Statista, in collaboration with insurance provider GeoBlue, invited tens of thousands of medical professionals in the selected countries to an online survey from September to November 2019. The survey was also promoted on Newsweek.com.
According to the Newsweek website, since 1819, Toronto General Hospital (TGH) has been a leader in cardiac care, organ transplants and the treatment of complex patient needs. TGH has focused on novel therapies to treat endocrine and autoimmune disorders ever since insulin was developed in Canada, and its first clinical use in the treatment of diabetes at the hospital was in 1922. This past year, the hospital’s doctors performed the first robot-assisted brain surgery on a live patient, which they hope will bridge even more frontiers, and eventually allow patients in remote communities to get this kind of live-saving care.
Canada, however, should not be resting on its laurels. Three years ago, The New York Times reported on a healthcare tournament it organized in which five experts decided which of eight rich countries had the best healthcare system. Not only did we not win, we went out in the first round, losing to Britain. Britain then lost to Switzerland, which ultimately beat France. Other first-round losers were Singapore, Australia and Germany. The US made it to the semis where it was beaten by France.
According to Aaron E. Carroll, professor of pediatrics, and health economist Austin Frakt, the US experts the Times relied on, “only 43 percent of Canadians were able to see a doctor or nurse on the same or next day when they needed care….Half of them had to wait two or more hours for care in the emergency room….30 percent of them had to wait two or more months to see a specialist….and 18 percent had to wait four or more months for elective surgery.” The Financial Post reported that these figures were all according to an international comparison published by the Commonweath Fund, which does world-leading research on health policy. On three of those metrics, we were dead last among 11 countries, and on the fourth, we were tied for last.
The experts didn’t blame our single-payer system. Britain has a single-payer too, yet Brits don’t suffer the wait times we do, which explained why they beat us 4-1 in the first round of the Times‘s competition. The experts also said that Canadians “have made the decision to accept” longer wait times in exchange for “significantly reduced spending.” And we do spend less on healthcare than Britain and, certainly the US, which spends twice as much as we do as a share of GDP. However, it’s not good enough just to beat the US. As the Times‘s tournament made clear, most of the systems that beat us involve more choices for patients and competition among suppliers than Canadian Medicare does, as well as shorter wait times.
According to Consumer Heath Ratings, a website that provides comprehensive listings of organizations that rate or report performance on specific hospitals, health plans, physicians, nursing homes, home health agencies and other healthcare providers in North America, the 2019 Canada Wait Times For Priority Procedures Report covered hip replacement, knee replacement, hip fracture repair, cataract surgery, and radiation therapy, for 2018 and each of the past five years. Province data from coast-to-coast showed wait times ranging from 48 hours for hip fracture repair, to 182 days for hip or knee replacement. A quick look at wait times for breast cancer surgeries in Ontario hospitals showed that 89 percent of patients were seen within the target time in the first quarter of 2020. For priority-four patients who should be seen within a target time of 35 days, they waited on average 15 days, which indicated that 92 percent of patients were seen within target time. The situation becomes less ideal when it comes to more urgent cases – for priority-two patients, who should be seen within a target time of 10 days, they waited on average seven days which indicated that only 84 percent of patients were seen within target time.
On length of stay in emergency rooms for all patients admitted to hospitals, on average, patients spent 11.2 hours and 48 percent of patients were admitted to hospital from emergency departments within a target time of eight hours. On more urgent cases, the waiting time is a bit better. For high-urgency patients not admitted to hospitals, patients spent on average 3.6 hours which indicated that 94 percent of patients finished their emergency visit within a target time of eight hours – still too long a time to wait!
While I’m proud to see four of our Toronto hospitals rated so highly on the Newsweek’s World Best, I believe it’s perhaps time for Canada to introduce a national hospital rating system. It will be a good start to make hospitals focus on patient protection first. The rating system needs to be fair, transparent and easy to understand. Hospital-acquired infections (HIAs) alone cost Canadian taxpayers more than $1 billion every year, yet Canada has one of the worst records for dealing with HIAs of all high-income nations, according to the World Health Organization. Hospital medical errors in Canada are the third-leading cause of death. A national rating system will help Canadians better understand and recognize our hospitals and also enable hospitals to minimize errors and inefficiencies.