Now that Donald Trump has been elected president, it’s worth revisiting the evolution of his views on Canada’s health-care system.

Although Mr. Trump started his campaign by stating that “[a]s far as single payer, it works in Canada,” - by the end of it, he did not seem to be a fan of Canada’s approach. In fact, most Canadians will more clearly remember his statements during the second presidential debate in St. Louis, when he opined that “…their system is so slow. It's catastrophic in certain ways”

While many took offence to this statement (catastrophic is a strong word), the data is clear—patients in Canada often wait too long for treatment. In fact, physicians report that their patients wait longer than what they consider to be clinically reasonable.

Some may counter that it’s a small price to pay in the face of the American alternative, but that’s a straw man argument. We should compare our system to other countries with universal health-care systems, not the U.S.

In fact, a recent study did just that. After examining 42 indicators of performance in 28 countries with universal health care, it found a general imbalance between the value Canadians receive and the relatively high amount of money we spend on our health-care system.

For example, while we ranked between 3 and 5 (out of 28) on age-adjusted measures of health-care spending, we had significantly fewer physicians (rank 24 of 28) and acute-care beds (rank 28 of 28) and psychiatric beds (rank 24 of 28) per capita than other high-income countries with universal health care in 2012. Canada also had fewer important diagnostic imaging devices (such as MRI and CT scanners) than the average high-income OECD country with universal health care.

Of course, medical resources are of little value if they aren’t used to provide services to patients. Canada’s record in terms of utilization of resources is a mixed bag. Canada reported higher rates than the average OECD country on some indicators (such as consultations with a doctor and cataract surgeries) and average to lower rates on the rest (hernia repair and hip replacements, for example). However, it’s notable that Canada reported the least amount of hospital activity (as measured by discharge rates) among universal health-care systems examined, suggesting a tight bottle-neck exists for the actual delivery of medical treatment in a hospital setting.

Our record in terms of quality was similarly mixed—doing well on some indicators (breast and colorectal cancer survival rates, for example), but very poorly on others (such as obstetric trauma and diabetes-related amputations).

Finally, in terms of timeliness of care, Canada either ranked last or close to last on all indicators.

An important take-away from these results, however, is that Canada’s performance is ranked in comparison to other universal health-care systems. So clearly, the way we organize our universal health-care system has led to this remarkable imbalance between the amount we spend and the poor performance in terms of availability of medical resources and timely access to care.

Regardless of how Canadians feel about the president-elect of the United States, it’s time for us to identify and accept the flaws in our health-care system and rework it to better serve patients in the future.