Canadians take great comfort in the belief that our health care system — a key part of our national identity — is world class.

But an unsettling report ranking Canada near the bottom in a comparison of health care in 11 developed nations raises questions about the quality of care we’re actually receiving. It highlights the need for improvements – particularly making sure patients have better access to doctors – that Ottawa and the provinces must make to guarantee healthcare remains a source of pride for all Canadians.

The study by the New York-based Commonwealth Fund gives Canadian health care comparatively low marks in categories such as access to the system, equitable care for all residents, and healthcare outcomes. It isn’t a perfect study: one drawback is that it combines data from each provincial health care system to give a general picture of the whole country, even though there are significant differences among provinces.

Overall, Canada came in ninth, ahead of France and outperforming the United States by a relatively wide margin (the organization’s findings are not kind to its host nation — the results paint a picture of an American healthcare system with serious flaws). The United Kingdom ranked first, with Australia and the Netherlands close behind.

Canada’s health care performance, according to national surveys conducted in 2016 in each of the 11 countries, is lagging in some key areas. We ranked last in ability to get same-day or next-day appointments when sick, with 53 per cent of Canadians reporting they could not get such access. In the Netherlands, which ranked first, only 19 per cent could not get such appointments.

We ranked next to last for difficulty in receiving after-hours care, with 63 per cent of Canadians surveyed reporting such access is problematic. Canada also has the highest percentage of patients who wait more than four months for elective surgeries, with 18 per cent who needed surgery within two years of the survey reporting such delays. We also came last in the measurement for access to specialists, with 30 per cent of Canadians reporting it took two months or more to see a specialist, compared to 6 per cent in the U.S. and just 3 per cent in Germany.

The takeaway is that, despite the many positive features of Canada’s universal health care system, there’s an urgent need for improvement in some areas.

For example, according to the data, access to health care could be greatly improved if we had more doctors. Among the 11 advanced countries, Canada has the fewest doctors per 1,000 residents. In 2014, we had 2.5 doctors for every thousand people. Norway had 4.4 and the U.S. was only slightly better than Canada, with 2.6.

This means Norwegians have almost twice as many doctors available for each resident than do Canadians. That’s unacceptable in a nation where health care is often held up as a shining example for the rest of the world.

How should we address the shortcomings highlighted by the Commonwealth Fund report? Possibilities include using our immigration system to attract more foreign-trained doctors; a faster process for accrediting foreign-trained physicians already here; better incentives to attract doctors to the most underserved areas; and creating more spots in Canadian medical schools.

In Ontario, the doctor shortage could grow worse if the amount of money paid to physicians continues to be outpaced by other provinces. According to the Canadian Institute for Health Information, as of 2016 the annualized increase for expenditures on doctors in Ontario was 0.8 per cent. This compared to an annual growth rate in Manitoba of 6.9 per cent, 3.2 per cent in British Columbia and 2.1 per cent in Alberta.

That shows the government has successfully controlled spending on doctors’ services, but it comes at a cost. With the province’s finances stretched, it’s very difficult to put substantial amounts of new money into the system even as our population grows and continues to age.

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That puts a special burden on the federal government to raise its spending on healthcare to at least 25 per cent of the public system’s overall funding, from its current level of about 23 per cent. If that doesn’t happen, future measurements of health care around the world could see Canada fall even further behind.

It would be entirely un-Canadian to allow that to happen. Health care is one of our most vital and cherished institutions and we have a responsibility to face its shortcomings head-on.