Newfoundland and Labrador's health care system placed last in the inaugural Canada Health Consumer Index released Tuesday while Ontario was the leader, based on measurements such as wait times, health outcomes and value for spending.

The Frontier Centre for Public Policy, a Winnipeg-based think tank, and the Health Consumer Powerhouse, a Swedish organization that compiles consumer information on health care, released the report, which assess the 10 provinces in terms of a set of consumer-oriented indicators.

"Overall, something that I found a bit surprising … is that there's no real relationship between the amount of spending that provinces put into the health care system and either the medical outcomes or waiting times or performance overall from the consumer's perspective," said report author Rebecca Walberg.

Some of the best scores were achieved by provinces that did not spend much per capita while provinces with the highest spending did the worst, Walberg said.

"The big changes that need to be made are not just about funding levels," Walberg told CBCNews.ca.

The report assessed provinces according to the following categories:

• Wait times for care: includes a range of indicators — from access to same-day care for minor problems to prompt cancer radiation and delays in access to new drugs.
• Primary care: including percentage of the population that has a family doctor, choice of accessing obstetrical care such as a midwife, home care and long-term residential care.
• Patient rights and information: the existence of a law with meaningful guarantees, a registry of doctors' credentials and a 24/7 telephone line offering advice from a registered nurse or equivalent health care professional,
• Outcomes: infant and heart attack mortality, five-year cancer survival rate, avoidable deaths, total incidence per 100,000 people of the infections MRSA and C. difficile.
• Generosity: number of cataract operations per 100,000 people (age adjusted), HPV and newer childhood vaccines, percentage of seniors immunized against influenza, percentage of households who spend more than one per cent of their income on pharmaceuticals and percentage of new approved drugs that are subsidized by the province.

Newfoundland had the second highest spending per capita, but its overall performance earned the lowest "bang for the buck" in terms of spending health care funds effectively. The province scored 592 points out of a possible 1,000 points, with outcomes and generosity identified as weaknesses. Only 21 points separated it from Saskatchewan, which was in second-last place.

Ontario was first overall, with 762 points, of which the highest scores were in primary care and generosity.

Learning from mistakes, provincial standouts

"Our hope is that the provinces will learn from the mistakes of their neighbours without replicating them," wrote Peter Holle, the Frontier centre's president, and Health Consumer Powerhouse president Johan Hjertqvist in a foreword to the report.

"There are also good examples to be found that should be adapted as made-in-Canada solutions by as many provinces as possible."

British Columbia and Nova Scotia took second place, with excellent scores for patient rights and outcomes. B.C. also scored well on administration, perhaps because of its unique system of sharing responsibilities for health care delivery with local authorities, Walberg said.

Provinces ranked fourth through eighth were: New Brunswick, Alberta, Prince Edward Island, Manitoba and Quebec.

Quebec scored low overall, with 679 points, but made do with a very small budget compared to other provinces, which shows efficient spending, the report said.

Even the best-performing provinces did not provide the standards common in Europe, where the benchmarking approach was pioneered, the report said.

Drug industry critic Dr. Joel Lexchin, a professor of health policy at Toronto's York University, pointed to what the report omits, such as the percentage of children who receive all recommended vaccinations rather than just the new HPV vaccine for cervical cancer, and measures that would show the effectiveness of hospital care, such as the percentage of people readmitted to hospital after surgery.

Readmission figures were not included because of the lack of data at the provincial level, Walberg said.

The focus on percentage of new approved drugs subsidized by the province fails to consider research published in the New England Journal of Medicine suggesting that drugs that are approved faster may have more safety problems, Lexchin pointed out.

Walberg said the choice to focus on cutting edge medicines that are shown to be safe and effective was justified.

The Frontier centre describes itself as an independent public policy think tank that does not accept government funding.