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The reality is that
for-profit provision of health-care services is commonplace among industrialized
countries with universal health care
By
Bacchus Barua
and Jason Clemens The Fraser Institute
VANCOUVER,
B.C. /
Troy Media/ - For almost
two decades, fear of a U.S.-style system has fuelled opposition to genuine
reform of Canadian health care. Many of those same opposition voices are now protesting
the constitutional
challenge to Canada's health regulations by the former head of the Canadian
Medical Association, Dr. Brian Day.
In reality,
our health-care system is expensive, delivers poor-to-modest results, and fails
to achieve many of its laudable aspirations. The solution to fixing and
maintaining our universal health-care system is to recognize the successful
approaches used in other universal-health care countries, such as the use of
for-profit companies to deliver health-care services.
The Dr.
Day case, which will likely end up in the Supreme Court of Canada, focuses on
two aspects of British Columbia's health regulations: (1) prohibition against
doctors working in both the public and private health-care systems, and (2) the
disallowance of purchasing private insurance for core medical
services.
Legal
arguments aside, the context of the case is worth noting. Canada is one of the
highest spenders, on both a per person basis and as a share of the economy, on
health care among industrialized countries that provide universal health
coverage. Yet Canadians endure some
of the longest wait times for medically necessary procedures. For example,
in 2015 Canadians waited 18.3
weeks between referral by a GP and actual treatment. Canadian patients also
suffer from comparatively poor access to doctors and medical technologies such
as MRIs.
But if the
voices of opposition at the Dr. Day trial are to be believed, there's an
incompatibility between medical care delivered by private, for-profit companies
and universal health care.
The
reality, however, doesn't match this rhetoric. A recent study
looked at for-profit insurers and hospitals in six industrialized countries
(Australia, France, Germany, the Netherlands, Sweden and Switzerland) that all
maintain universal health care.
For-profit
hospitals are found in all six countries. In Germany, France and Switzerland,
for instance, universally accessible hospital care is delivered by both
non-profit and for-profit hospitals. In Australia and Sweden, governments
contract with for-profit hospitals for universally accessible
services.
For-profit
health insurers are also found in all six countries. Notably, for-profit
companies compete to offer the primary health-care insurance in the Netherlands,
offer a private substitute for public health-care insurance in Germany, and
offer a private option alongside the public system for patients in Australia and
Sweden.
Remember,
all six of these countries maintain universal health care.
But
Canadians need not look beyond our own borders to see the benefits of private,
for-profit provision of health services. Saskatchewan's Surgical
Initiative (SSI) was introduced in 2010 with the express goal of reducing
what were the country's longest wait times for medical treatment.
Under the
SSI, select day surgeries were contracted out to private, for-profit clinics. A
recent
study by the former NDP finance minister of Saskatchewan, Prof. Janice
MacKinnon, provided evidence that on average, private clinics delivered
procedures at 26 per cent lower costs than public-sector equivalents. For
example, in 2012, Regina Surgical Centres Inc. provided cataract surgeries at
$618 per procedure compared to $1,273 in public hospitals in the Regina
Qu'Appelle regional health authority.
The
results in Saskatchewan have been stunning. The province has gone from having
some of the longest wait times, on average, for medical treatment to having the
shortest. The government's own wait time data
indicates a decline of 75 per cent in the number of patients waiting three
months or longer for surgery.
The
reality is that for-profit provision of health-care services is commonplace
among industrialized countries with universal health care. Canada is actually
the oddity in limiting - and in some cases, actually prohibiting - such
activities. Hopefully the Dr. Day case, if nothing else, will bring these
important reform lessons to light for Canadians.
Bacchus Barua and Jason Clemens are economists at the Fraser
Institute.
© 2016 Distributed by Troy
Media
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HEALTH
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