Alberta is Heading Down the Right Path

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Appeared in the National Post, 03 March 2006

The fear mongers are out in full force in response to the Alberta government’s plan to reform the province’s health care system. Led by Ontario Premier Dalton McGuinty and echoed by Saskatchewan Premier Lorne Calvert, their intention is to convince Canadians that their guaranteed access to health care will disappear if a precedent is set by Alberta’s proposed Third Way. As usual, the critics’ claims do not stand up to close scrutiny.

Consider the claim that private parallel health insurance or treatment would mean Albertans -- or Canadians in other provinces undertaking similar reforms -- would no longer enjoy access to care regardless of their ability to pay. Ray Martin, Alberta’s NDP House Leader, is claiming the province is moving toward cheque-book medicine. The facts clearly demonstrate that this is not the case.

Canada is the only developed nation with a universal access health insurance program that does not allow private contracting for medically necessary treatment. In each of the other 27 developed nations where a universal access health insurance program exists, patients have the freedom to choose between competing financiers of care. Not one of these nations has had to abandon the principle of access to care regardless of ability to pay -- a fact recognized by the Supreme Court of Canada.

Fear mongers also oppose allowing private competitive health care providers to deliver publicly funded care, claiming these providers will be more expensive and of a lower quality than the public ones. But on the contrary, private providers would inject much-needed resources and capacity into our overburdened program and are known to speed up access to high-quality publicly funded treatment for patients in a cost-effective manner. That has been proven not only in nations such as Sweden, Spain and the U.K., but also in Canadian provinces such as British Columbia and Alberta.

Yet another claim, made by many, including Ontario Health Minister George Smitherman, is that allowing physicians the freedom to practise in both private and public sectors will reduce access to publicly funded care.

That would only be true if the publicly funded program were making efficient use of physicians’ time. In actuality, the output of physicians in Canada is limited in a number of ways, including annual limits on billings and restrictions on the number of certain surgeries that can be delivered.

Physicians are also limited in their access to operating rooms, with some surgeons receiving as little as four hours of operating time per week. There are spare physician resources in Canada in terms of hours of service available, but the number of doctors is limited. Allowing Albertans to access the down time during which physicians are simply unable to provide publicly funded care stands to benefit patients and doctors alike.

Then there is the hysteria around user fees or co-payments, which were floated in this week’s 10-point proposal (They are mentioned in the context of long-term sustainability and funding options). Critics suggest user fees would encourage patients to wait until the last possible moment for treatment, thus suffering much more than they would otherwise and costing more to treat in the long-run. The research on cost-sharing for medically necessary care and international experience tell a different story.

According to the evidence, requiring patients to share in the cost of their care, with appropriate exemptions for those in a state of low-income, means more informed decisions about when and where the system is accessed. The result is greater availability of services for other patients and reductions in the use of services overall, without any negative impact on health outcomes. Not surprisingly, the majority of the developed world’s universal health insurance programs require cost sharing.

The reality is that Canada’s health care program is the developed world’s third-most expensive universal-access medicare program (age-adjusted), and yet delivers some of the worst access for patients. Similarly, Alberta’s health program is presently among the most expensive in Canada but delivers access to care that does not stand out in any way from the others.

Those opposed to Alberta’s plan are effectively claiming that aligning the province’s health care policies with those employed in the developed world’s most successful universal access systems -- policies that have proven themselves superior -- will make for a worse universal access health care program. Clearly, the departure from the status quo is not the problem. The real problem is that Alberta’s plan doesn’t go far enough fast enough.

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