Klein's ‘Third Way' Has Worked Wonders in Other Countries

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Appeared in the Saskatoon StarPhoenix, January 17, 2005

Earlier this week, Premier Ralph Klein proposed a new approach to health care in Alberta: private providers delivering care funded by the provincial government. Though the idea may seem revolutionary to Canadians, many other nations in the developed world have been enjoying the immense benefits such policies create. Injecting a little competition into the health care system, however, is only the first step towards the creation of a truly world class health care program in Alberta.

A truly world class universal access health care program is characterized by either the very best outcomes health care can deliver, or the absence of waiting times, or both. Nine nations meet the requirements: Austria, Belgium, France, Germany, Japan, Luxembourg, and Switzerland have programs that provide health services without waiting lists, while Australia, France, Japan, and Sweden outperform Canada on measures of health outcomes from care. All of these nations incorporate private hospitals within their public health care programs.

Innovative private entrepreneurs have generated immense benefits for patients in the aforementioned countries as well as others. In Spain, for example, introducing publicly funded contracts with private providers was a core component of a very successful package that dramatically reduced average waiting times (by roughly 68 percent) in the late 1990s. The introduction of privately owned hospitals and a more competitive hospital sector in Sweden led to more cost-efficient delivery of services and to a reduction in waiting times for patients receiving publicly funded care.

These are but two examples of the benefits that competition and privately provided care create when incorporated into a public health care program. For Alberta, however, reform must not stop there. The goal for Mr. Klein and all Albertans should be the creation of a truly great health care program that delivers high quality health care without waiting times, not just better services and shorter waiting times.

Accomplishing this will take much more than Klein’s ‘third way’. While no nation has eliminated waiting times without private competitive delivery of publicly funded services, none of those 9 nations with world-class health programs managed that performance without two other vital components of a well functioning health care program: responsibility for patients to cover some of the cost of health services they consume and the freedom to access private providers with private resources.

Implementing a cost sharing policy would have profound effects on the efficiency and cost of health care in Alberta and elsewhere in Canada. Access to family physicians and clinics would be improved for those in need as some patients (as many as 25 to 30 percent) will opt to save the charge and not seek medical attention. Remarkably long waiting times for emergency care would also fall as patients requiring attention for non-critical conditions would seek care in more cost-effective settings. Savings that result from these effects, which have been shown to not adversely affect the health of patients if appropriate exemptions and limits are in place, could then be used to treat the health care problems that reside on provincial waiting lists or allow for tax relief that would benefit the economy as a whole.

Allowing patients the freedom to seek care on their own terms is also a necessary component of a world class health care program. In Canada the injured and ill are prisoners of the bureaucratic will, bound to the public health care system and given no opportunity to choose when and where they will receive care, even if the government is unwilling to offer it. Allowing these individuals to purchase health services privately gives them additional choices with regards to when and where it is most appropriate for them to receive health services, and creates competition which can lead to a better and more responsive public health program.

These reforms could also create a less expensive health care program. At present, no developed nation spends more (on an age adjusted basis) to purchase universal access health care for their populations than we do. And yet, most nations enjoy better access to advanced medical technologies and physicians, while some nations, through those key health policies, are able to deliver universal access to health services without waiting times.

Following the path that begins with Mr. Klein’s ‘third way’ will bring Canadians closer to the goal of having the best universal health care system in the world. Heeding comments like those from Ontario Premier McGuinty and Federal Public Health Minister Bennett, who strongly oppose rational, reasonable, informed, and intelligent reform will continue to shackle Canadians to a substandard health program that costs far too much for what it delivers. Canadians can only sit and hope, fingers-crossed, that Mr. Klein has the resolve to show Albertans the immense benefits that competition, responsibility, and freedom have generated for patients in other parts of the developed world.

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