Patients line up on hospital beds outside a crowded emergency room at Montreal's Sacre Coeur Hospital in 2002. (Paul Chiasson/CP Photo)

Canada earned a B grade on health-care outcomes compared with a D for the U.S., but trailed several other countries, according to a report card released Monday by the Conference Board of Canada.

The annual report ranked Canada 10th out of 16 developed countries, the same as last year. The United States was ranked last in the report card, which mostly used 2006 data on life expectancy, mortality due to cancer, circulatory diseases, respiratory diseases, mental disorders, as well as infant mortality and self-reported health status.

"Canada has been at the centre of much of the debate on U.S. health-care reform. Since Canada ranks ahead of the U.S. on all but one indicator of health status — mortality rate due to cancer — it is clear that we are getting better results," said Gabriela Prada, director, of health policy at the Conference Board.

"But when we look beyond the narrow Canada-U.S. comparison to the rest of the world, Canadians rank in the middle of the pack in terms of their health status," Prada added in a statement.

U.S. President Barack Obama has promoted a $2.5-trillion US national health-care plan that would place limits on how much people can be charged for out-of-pocket expenses, and require insurance companies to cover routine checkups and preventive-care procedures such as mammograms and colonoscopies.

Diabetes alarm bell

Obama's proposed reforms have sparked a fierce debate in the U.S., with both supporters and critics pointing to Canada's system to support their claims.

Canada and the U.S. both earned As on self-reported health status, receving first and second spot on that indicator in the board's report.

In the report, Canada got no Ds on any of the 11 indicators and received Cs on mortality due to diabetes (14th place) , musculoskeletal diseases (10th) and infant mortality (15th).

The increasing levels of mortality due to diabetes should raise alarm bells for all Canadians, Prada said, since the burden of chronic disease is expected to grow as the population ages.

Wait times, lifestyle factors

Japan was the top-ranked country in the report, with Switzerland, Italy, and Norway also earning A grades.

Most of these top-performing countries achieved better health outcomes by acting on the "determinants of health," such as environmental stewardship and health promotion, the report's authors said.

The authors praised Canada's universal access to health-care services, highly skilled and committed health-care professionals and internationally recognized institutions.

But it pointed to challenges such as wait times for some diagnostic and treatment services, management systems that aren't focused enough on quality-of-health outcomes, lifestyle factors such as aging, smoking, drinking, physical inactivity and poor eating habits, along with education and early childhood development.

In the report, Canada, Sweden, France, Finland, Germany and Australia got Bs, while the Netherlands, Austria and Ireland earned Cs.

Denmark and the United Kingdom joined the U.S. at the bottom of the rankings with Ds.