Executive summary

As Canadians, we all want to optimize our health status and be assured of health care that is effective, timely and delivered by compassionate providers attuned to our needs and those of our families. In an era of increasingly complex medical care and escalating costs, provincial and territorial governments are attempting to balance these public expectations with their pressing fiscal responsibilities. Health care decision-makers, including provincial and territorial ministries of health, local health authorities and hospital administrators, are increasingly relying on a broad range of indicators to gauge the health of the Canadian population, the quality of hospital care and the performance of health care systems.

Reports that rank the health of Canadians and Canada's health care systems according to these indicators are widely reported in the media. These reports often attempt to condense a complicated array of statistics on population health and health care into a relatively simple number, a rank that is used to make international and provincial comparisons. But in recent years, these reports have often been inconsistent. In one report, Canada is ranked 11^th among 24 developed countries, and in another Canada is ranked 23^rd out of the 30 countries compared on the basis of the performance of their health care systems.^{1, 2} Unlike a familiar economic indicator—the gross domestic product (GDP), which represents a complex entity (the total market value of all goods and services produced in a country in a given year) with a single number calculated according to an internationally agreed upon methodology—rankings of health and health care are not yet standardized nor well understood.

This methodology paper aims to improve readers' understanding of ranking reports. It outlines the components and processes that underlie health rankings and explores why such rankings can be difficult to interpret. The paper concludes with a checklist to help readers judge and compare the value of health-related rankings.