Philpott should act on instincts and promote Dutch-style health-care reform in Ontario

The Ford government recently appointed Dr. Jane Philpott, former federal health minister in the Trudeau government, chair of a “new primary care action team” in Ontario.

During her three-year term as federal health minister, Philpott openly acknowledged the failures of Canadian health care and expressed interest in lessons from abroad. However, somewhat perplexingly she simultaneously intensified pressure on provinces to adhere to the very aspects of the Canada Health Act that prevent provinces from implementing those lessons. The result? Policy inertia.

And yet, she still seems interested in those lessons. While her new role in Ontario will remain narrowly confined to primary care—that is, a patient’s first point of contact with the health-care system, usually with a family doctor—earlier this month, Philpott advocated for health-care reform based on the Dutch model. Indeed, policymakers in Canada can learn from the Netherlands about a broad spectrum of policy options including the role of the private sector, patient contributions to the cost of care, and how hospitals are incentivized to provide treatment.

According to our recent study, after controlling for differences in age (where appropriate) between the two countries, the Dutch health-care system outperformed Canada’s system on 27 (of 39) performance measures in 2021.

For example, the Netherlands had more physicians, nurses and MRI machines per person compared to Canada.

Patients in the Netherlands also received more timely access to care. Only 38 per cent of Canadians were able to get a specialist appointment within four weeks compared to 69 per cent of Dutch patients. And only 62 per cent of Canadians received scheduled surgery within four months compared to 87 per cent of Dutch patients.

Crucially, higher spending does not drive this higher performance. Our study found that the Netherlands spent a broadly comparable amount on health care compared to Canada in 2021.

While Philpott correctly identifies some important differences in the Dutch approach to primary care (specifically, its reliance on primary-care centres with teams of health-care professionals), in reality the Dutch have a completely different approach to universal health care. One that, judging by the data, Canada should emulate.

For starters, the Netherlands ensures universal coverage through a compulsory insurance scheme. Dutch residents must purchase universal health-care insurance from one of several private insurers, in a regulated but competitive market, with low-income families receiving assistance with premium payments. While premiums can vary between insurance companies, each insurer must determine a flat premium for adults that applies uniformly across the country regardless of individual health status or other factors. And insurers must accept all applicants for coverage.

Demand for services is also tempered by patient cost-sharing. In 2020, Dutch patients were expected to pay an annual deductible of 385 euros (C$533) for most types of care including access to specialist consultations and hospital care. Once this deductible is met, all further costs are covered by insurance. Of course, vulnerable populations including low-income families, expecting mothers and patients with chronic illnesses are protected via safety nets and exemptions.

Moreover, unlike most Canadian hospitals, Dutch hospitals are primary funded per-patient treated—and receive money according to the number and complexity of cases completed, encouraging a patient-focused approach and higher productivity. By contrast, most Canadian provinces largely fund hospitals via “global budgets” where hospital funding is set at the beginning of the year based on historical trends and not directly connected to real-time demand for services. As a result, hospital funding in Canada fails to encourage efficiency and higher volumes of service provision, and actually discourages the treatment of complex cases because patients are viewed as a cost.

These three key differences—privately operated universal insurance, patient cost-sharing, and activity-based funding for hospitals—differentiate the Dutch approach to universal health care compared to Canada’s ailing and failing model. Philpott should be commended for identifying the Netherlands as a model for reform. But instead of narrowly focusing on primary care, policymakers in Ontario and across Canada should focus on system-wide reform based on the Dutch model to truly improve universal health care for Canadians.