The Castonguay Commission report contains both good and bad ideas, embracing some policies that have proved successful in the universal health insurance systems of countries like Sweden. But the commission is wrong to suggest increasing taxes to finance health care. Medicare doesn’t need money; it needs reform.

Canada’s health care program is the developed world’s third most expensive universal health insurance program (after accounting for the age profile of the population) and yet delivers relatively poor access to care. While Quebec’s performance might be better than some other provinces’, it remains behind the performance of the majority of OECD nations despite being more costly than most.

Fortunately, Quebec’s Health Minister rejected the recommendations to increase the Quebec sales tax and create a health-stability fund.

However, the minister was not enthusiastic about other positive recommendations that should be further explored. These include independent private management and ownership of hospitals providing publicly funded care. Both economic research and international experience show that competitive private provision of services is more cost-efficient and produces a higher quality of care than the monopolistic public provision of services that exists today.

Expanding private parallel financing of care is not a move away from the principle of access to care regardless of ability to pay. A parallel system offers Canadians whose needs are not being met by the public program a choice. This frees up capacity in the public program and creates choice in the financing of care to the benefit of both those who choose to pay for care privately and those who do not.

By allowing individuals to pre-fund health care through premium payments over time, private health insurance creates opportunities for those in lower income groups to afford privately funded health care. Private insurance also allows people who would rather pay an anticipated premium over time than a higher and less predictable cost at the time they needed care to do so.

Claims that physicians will be drawn away from the delivery of publicly funded services are misleading and rely on the assumption that Canadian physicians are unable to provide more services than they currently deliver through the public program. Despite the relative lack of physicians in Canada, many Canadian physicians have trouble accessing operating rooms or are unable to treat patients because of provincial quotas and limits.

Cost sharing or incidental fees (i.e. a charge for every visit to a doctor), are also a good idea and should be expanded to apply to more than just one point of entry to the health care system.

According to research and international evidence, when patients are directly responsible for some of the cost of their care, they make more informed decisions about when and where to best access the health care system. This improves access for other patients and saves money overall.

Importantly, patients end up no worse off in terms of health outcomes as long as low income populations are exempted from the cost sharing scheme.

Following the path that begins with the Castonguay Commission’s report will in many ways bring Quebecers closer to the goal of having a universal access health care system that delivers quick access to high quality care. While the commission could have gone further towards the health policy constructs of nations like Switzerland where waiting lists for access to world-class health care services are nonexistent, it is clear that this report is a step in the right direction.