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Money Doesn't Buy Top Performance in Provincial Health Systems

Ontario, New Brunswick and Nova Scotia rank highest among Canadian provinces for their performance in delivering health care services, according to new Conference Board of Canada research released today at the Western Summit on Sustainable Health in Edmonton.

Edmonton, May 22, 2013—Ontario, New Brunswick and Nova Scotia rank highest among Canadian provinces for their performance in delivering health care services, according to new Conference Board of Canada research.

The health system resources and performance grades are part of a major report, Paving the Road to Higher Performance: Benchmarking Provincial Health Systems.

“Spending larger sums of money on health care does not necessarily translate into better performance. It is how money is spent, rather than how much, that will deliver better value for Canadians,” said Gabriela Prada, Director, Health Innovation, Policy and Evaluation.

“Our analysis is not meant to ‘shame and blame’ provinces that do relatively poorly on any given indicator,” said Prada. “Our intention is to identify performance achievements and gaps so that all provinces are better equipped to make decisions that will improve health care systems and population health.”

The findings released today are the third and fourth categories published by The Conference Board of Canada in its benchmarking of provincial health systems, produced under the Canadian Alliance for Sustainable Health Care. In all, 90 indicators are assessed in the categories of Lifestyle Factors, Health Status, Health Resources, and Health Care System Performance.

The Health Care System Performance category includes seven sub-categories – screening and prevention, accessibility, effectiveness, appropriateness, continuity, patient centredness, and safety. Since Health Care System Performance comprises 47 of the 90 total indicators, the system performance grade will have a strong influence on a province’s overall grade.

Alberta is the lone province to receive a “B” in Health Care System Performance. British Columbia, Saskatchewan, Manitoba, and Quebec receive “C”s. The lowest grades are awarded to P.E.I. and Newfoundland and Labrador.


Regarding the resources put into the health care system, Nova Scotia, New Brunswick, Quebec, and Newfoundland and Labrador have more per-capita resources (providers, medical equipment, and hospital beds) than the other Canadian provinces.

Chart of provinces graded by health system resources

Although the assumption is often made that more resources is likely to lead to better system performance, good results can be achieved with fewer resources. Despite relatively limited number of providers, medical equipment and hospital beds when compared with other provinces, Ontario gets top grades on health care system performance. Quebec has among the highest resources per capita, yet gets a “C” in health care system performance. Newfoundland and Labrador has among the highest level of health resources per capita, but gets a “D” in health care system performance.

The Conference Board of Canada benchmarks performance using an A-B-C-D report card ranking methodology. Grade levels are assigned to the indicators using the following method:

  • For each indicator, the difference between the top and bottom performer is calculated and this figure is divided by 4.
  • A province receives a report card rating of “A” on a given indicator if its score is in the top quartile, a “B” if its score is in the second quartile, a “C” if its score is in the third quartile, and a “D” if its score is in the bottom quartile.
  • This methodology helps to ensure that those regions awarded an “A” on a given indicator perform substantially better than the range of performances among the other regions.

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