Fraser Forum

Where patients are prisoners to bureaucratic will

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It has been well-established that, despite spending more on health care than the majority of developed countries that seek to provide universal access regardless of a patient’s ability to pay, Canada performs poorly on a number of key health-care indicators including the availability of medical resources and timely access.

Less discussed, is the fact Canada’s system differs from other successful universal health-care systems in very specific ways, including health care in Australia, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland and the United Kingdom. These countries all share the goal of universal access and generally perform on par or better on most indicators of performance. But again, they do universal health care very differently than we do.

One of the most startling ways Canadian health-care policy differs is its attitude towards the private sector. A recent study revealed that when compared to the countries mentioned above, Canada is the only country where private financing—either through an insurer, or direct payment—for medically necessary services is disallowed, leaving the government system as the only option for patients.

Although Australia, France, New Zealand, Sweden and the U.K. also belong to a group of tax-funded health-care systems that include Canada, all these countries allow private insurers to cover medically necessary health-care goods and services, often even when delivered by providers funded by the basic primary health-care system.

And then you have countries such as Germany, the Netherlands and Switzerland, which do universal health care in a radically different way. In these countries, multiple insurers compete in a regulated environment to provide basic benefits under the universal health-care umbrella.

Germany’s universal health-care system actually consists of two insurance systems—the Statutory Health Insurance (GKV) and Private Health Insurance (PKV)—both funded by premiums and provided by a number of competing independent insurers.

In the Netherlands, residents must purchase a standard insurance package from one of a number of private insurers, who may choose to operate on a for-profit basis in a regulated but competitive market.

Similarly, in Switzerland, the federal government is primarily concerned with ensuring universality (through legislation and supplementary funding) to its citizens in an environment of managed competition among insurance companies and providers of health care.

Of course, the most straightforward form of private financing is direct purchase of health-care services by individuals. Only in Canada are patients prisoner to the bureaucratic will, denied the opportunity to seek care on their own terms with their own resources when the government system is unwilling or unable to deliver the care they need in a timely fashion at an appropriate quality.

Clearly, our government’s attitude towards the private sector in the funding of medically necessary services is extraordinarily restrictive, and stands in stark contrast to countries with (arguably, more successful) universal health-care systems.


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