INSIDERS: Not a Class Act

Printer-friendly version
Appeared in the Medical Post, 13 June 2006
An examination of health care in Europe shows the Canada Health Act is not world-class

At least two provincial governments have mused about the implementation of sensible health policies guided by the more successful health-care models in Europe. The governments of Alberta and British Columbia seem to have accepted the reality others would rather not recognize: The single greatest barrier to the creation of a world-class health-care system is the Canada Health act itself.

The principles, rules and interpretations of the act, which are overseen by the federal government, restrict Canadian patients to an inefficient and unresponsive system by prohibiting beneficial and sound health policies that are demonstrably better than those enshrined in the Canada Health Act.

An examination of the evidence shows just how poorly Canada’s health program performs relative to universal access programs elsewhere. Of the 28 most developed countries 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. However, Canada manages to rank near the bottom in access to technology and physicians, while Canadian patients wait longer than patients in most other countries and enjoy satisfactory but not exemplary outcomes from care.

Of the 27 other universal access health-care programs, several 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 requires that patients share some of the costs of their care—a policy 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 and end up no worse off in terms of health outcomes.

These countries also allow private providers to deliver publicly funded health care. In those countries where waiting lists are insignificant, private providers openly compete for delivery of publicly funded care. In Sweden and Australia, private providers have contracted with some regional governments to provide care for patients. Each of these countries enjoys the cost savings and improvements in quality of care and efficiency that private competition creates.

While Alberta and British Columbia have contracted a small range of surgeries to private suppliers, neither has allowed fully private operation of an acute care hospital nor encouraged open competition in the delivery of surgical or hospital services.

Finally, not one of these top-performing countries has outlawed an individual’s right to contract privately for their own care—a freedom prohibited by governmental interpretations of the Canada Health Act and possibly by the act itself. Canada is, in fact, the only developed country that deems it necessary to disallow private contracting for health care in order to sustain a system intended to provide care for all citizens.

Canadians want access to timely, reasonably priced and high-quality care. Evidence from Europe and elsewhere in the developed world clearly demonstrates wholesale reform of our universal access health insurance programs based on the principles of competition and appropriate financial incentives will lead to the higher-quality, more efficient and more affordable health care Canadians desire.

A commitment to the Canada Health Act as it stands serves only to commit Canadians to a health program that provides poor value for money.

Subscribe to the Fraser Institute

Get the latest news from the Fraser Institute on the latest research studies, news and events.