BC's Throne Speech Offers the Sensible Path
In this weeks Throne Speech, the BC government suggested the Canada Health Act be modified to allow the implementation of sensible health policies guided by the more successful health care models in Europe. This statement follows several similar ones from the Alberta government next door. The provincial governments of Alberta and BC seem to have latched on to a reality that others would rather not recognize: the single greatest barrier to the creation of a world-class health care system in Canada is the Act itself.
More specifically, the rules, interpretations, and principles of the Act, which are overseen by the federal government, have confined Canadian patients to an inefficient and unresponsive system by prohibiting many of the most beneficial health policies. Policies that are demonstrably better than those currently employed in Canada and enshrined in the Canada Health Act.
An examination of the evidence shows just how poorly Canadas health program performs relative to universal access programs elsewhere in the developed world. Of the 28 most developed countries (including Canada) that guarantee access to health care insurance regardless of ability to pay, Canada ranks third and only slightly behind second-ranked Switzerland for age-adjusted expenditures on health care. Despite that high level of expenditure, Canada manages to rank near the bottom in terms of access to technology and physicians, while Canadian patients wait longer than patients in most other countries and enjoy reasonable but not exemplary outcomes from care.
Of the 27 other health care models that offer universal access to care, several countries stand out as possible models for Canada. Sweden, Japan, and Australia provide better health outcomes for their citizens. At the same time, Austria, Belgium, France, Germany, Japan, Luxembourg, and Switzerland deliver health care without any significant wait times. Note that Japan actually manages to achieve both.
These countries all manage a superior performance to Canada by employing policies that have either been specifically outlawed by the Canada Health Act or that have been interpreted as inconsistent with the principles of Medicare by previous federal governments.
Each of these countries that deliver superior access or quality of health services requires that patients share some of the costs of health carea policy that has been specifically forbidden by the rules and regulations of the Canada Health Act. According to research and international evidence, when patients are responsible for some of the cost of their care, they use fewer resources (making more available for other patients and saving money overall) and end up no worse off in terms of health outcomes.
These countries also allow private health care providers to deliver publicly funded health carea policy that was generally forbidden by the past federal governments interpretation of the Act. In those countries where waiting lists are insignificant, private providers openly compete for the delivery of publicly funded care. In Sweden and Australia, private providers have contracted with governments to provide care for patients in specific regions. Each of these successful countries enjoys the cost savings and improvements in quality of care and efficiency that private health providers create.
Finally, not one of these countries has seen fit to outlaw an individuals right to contract privately for their own carea freedom also prohibited by governmental interpretations of the Canada Health Act and possibly by the Act itself. Canada is, in fact, the only developed country that sees it necessary to disallow private contracting for health care in order to sustain a health care system that is intended to provide care for all citizens regardless of ability to pay. Patients anywhere else in the developed world are free to seek care on their own terms if they desire to do so
Canadians want access to high-quality care, delivered in a timely manner, at reasonable cost for the taxpayer. The only way to meet all of these desires is through the responsibility that comes from cost sharing and the competition created by private provision and funding of medically necessary health care services. Unfortunately for Canadians, the greatest barrier to the implementation of these policies is the very legislation often claimed to be the guarantor of quality public health care.
The provincial governments of BC and Alberta have suggested that needed health reforms may not be consistent with the Canada Health Act. Evidence from Europe and elsewhere in the developed world clearly demonstrates that wholesale reform of a universal access health care program based on the principles of competition and appropriate financial incentives, will lead to a higher quality, more efficient, and more affordable program for Canadians.
We can only hope that the new and future federal governments have the foresight to realize that such reforms will significantly improve the lives of Canadians. A commitment to the Canada Health Act as it stands serves only to commit Canadians to a health program that provides terrible access to care at a grossly inflated price.
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