Canada Going Against the Grain

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Appeared in the Windsor Star

When it comes to healthcare, Canada remains out of step with the rest of the industrialized world. Over the past 15 years or so, many countries with universal access health programs have been increasingly tapping into the competitive market for solutions to their health care woes. Others, like Japan and Switzerland, have always depended on competitive health care markets to deliver access to care regardless of ability to pay. Unfortunately in Canada, governments of all stripes remain steadfast in their dismissal of private sector solutions.

Just what do Canadians get for this steadfast commitment? For starters, among the 26 other developed nations that also maintain health care programs that guarantees access to care regardless of ability to pay, Canada’s is the second most expensive. In 2003, the most recent year for which comparable statistics are available, Canada spent 11 per cent of the total income earned by its economy on health care (age-adjusted), ranking it second behind only Iceland at 12.5 per cent.

For that level of spending, Canada ranked 24th for access to physicians, 13th for access to MRI machines, 17th for access to CT scanners, seventh for access to mammographs, and 18th for access to lithotriptors. The available evidence suggests that Canadians also suffer longer waits for treatment than patients in many other nations. When it comes to health care outcomes, Medicare ranks fourth, ninth, 10th, and second on various measures of mortality from disease that are closely related to health system performance.

This is not exactly the performance you would expect from the developed world’s second most expensive universal health care program. Perhaps a closer look at why other countries are getting more for less is in order.

Take Sweden, often thought of as a Mecca of socialist thought. The health care program in that country has long been taking advantage of competitive markets. In the mid-1990s, the Swedes began to rely on private management and operation of health care facilities. In fact, one of the largest hospitals in Stockholm, St. Goran’s, is privately operated by a for-profit company and competes with public hospitals for public dollars. In addition, the Swedes encourage competition by paying hospitals on the basis of services actually provided, unlike in Canada where hospitals generally get a lump sum of money each year. The effect is that hospitals actually have to worry about attracting patients and pay attention to what patients want and need. The end result is shorter wait times and more efficient service delivery.

The Spaniard’s are also catching on to this wave of market-based health care reform. A core part of their very successful wait time reduction program (which reduced average waits by roughly 68 per cent in the late 1990s) was publicly funded contracts with private providers.

Germany, and Switzerland, two nations who deliver access to care without queues and that have for many years relied on competitive private provision of publicly funded services, encourage patients to choose among competing insurers for their publicly guaranteed care. While that may sound remarkable or almost unbelievable to many Canadians, the universal access health care programs in these nations were originally built on the concept of several independent insurers that would cover the population through mandatory policies. The only difference now is that the independent insurers are being encouraged to compete amongst one another. Belgium, the Netherlands, the Czech Republic, and the Slovak Republic are also employing the concept of choice among insurers in their universal access health care programs.

The Germans and the Slovaks have further deviated from Canada’s model by increasing patient cost-sharing in their health care programs. When patients pay for part of the cost out of pocket they tend to make more informed decisions about when and where it is best to access the health care program. Other nations moving towards greater patient responsibility include the Netherlands which as of January 2006 is allowing cost sharing in their universal access health care program (though most residents are choosing insurance options without deductibles). Hungary intends to introduce official cost sharing into its health care program early next year.

The fact is, Canada is in a distinct minority when it comes to having no cost sharing for publicly funded services: more than three quarters of OECD nations which have universal access health care programs require patients to share in the cost of the care they consume.

No single solution to all of Canada’s health care woes exists. However, in the interests of all Canadians, we ought to be looking at what others are doing and adopt those policies that work best. Incorporating more competition in the provision of publicly funded hospital services, through policies like output-based remuneration for hospital care and allowing private hospitals to compete for the delivery of that care; allowing patients to seek care on their own terms with their own hard earned resources when they desire to do so, as all of these nations and every other developed nation with a universal access health care program allows; and implementing a cost sharing scheme for publicly funded services are proven policies that would improve the state of Medicare for all Canadians.

It is well time Canadians sat down and took an honest look at what works elsewhere in the developed world. Moving beyond the politics, rhetoric, and nonsense that has plagued discussions of health care reform for years is a must if we are ever to truly improve the state of Medicare in this great nation.

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