Modest Reforms Better Than None

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Appeared in the Calgary Herald, 22 August 2006
The latest revision of Alberta’s plan to reform the province’s health-care program, released Thursday, abandons proposals that would have seen a greater role for private health insurance and would have allowed physicians to practise in both private and public sectors simultaneously.

Despite caving in on these points, the Alberta government has once again attracted the ire of Alberta’s opposition parties, both of which oppose the government’s plan to expand the services delivered by private surgical facilities.

It is important Albertans understand that the political opposition to the proposal is contrary to the international evidence. Albertans must also understand this new proposal is a step backwards rather than an improvement on the previous plan.

Canada’s health-care program is the developed world’s third most expensive universal access health-care program (age-adjusted), and yet delivers some of the worst access to care for patients.

Similarly, Alberta’s health program is among the most expensive in Canada but delivers access to care that does not stand out from the others. The evidence shows clearly that the health-care program being so vehemently defended by the opposition parties in Alberta, as well as the provincial and federal governments, is a poor one.

The large disconnect between spending and access to care in Canada is in part driven by a lack of private-care providers -- precisely the opposite of that which Albertans are being led to believe by the provincial opposition. Flawed as it is, the Alberta government’s proposal is clearly a small step in the right direction.

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 per cent) 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. The Swedish health program outperforms Canada’s in terms of health-care outcomes.

The health-care programs in Japan and Australia also deliver superior health outcomes to Canada’s, and both of these nations allow private providers to deliver publicly funded health-care services.

Seven developed nations -- Austria, Belgium, France, Germany, Japan, Luxembourg, and Switzerland -- deliver universal access to health-care services without waiting lists. In each of these nations, private health-care providers openly compete to deliver health care paid for by the universal health insurance program.

The evidence also shows that Alberta’s proposal falls well short of creating a truly world-class health-care program. The eight-point plan ignores the two other key components that have contributed to international success stories: cost sharing for publicly insured services and private parallel health-care services. The key reason for these omissions is that the federal government controls sizable cash transfers for health care and would likely financially punish any province that implements such policies.

Albertans should also be concerned about proposals that could, depending on how they are implemented, end up negatively affecting the quantity and quality of health-care services that they receive. The inclusion in this new plan of proposals that might lead to rationing of new medical technologies and changes to the way physicians are paid could have that effect.

In total, the new health-care reform proposal takes a step backwards from the previous plan by giving up a key policy that would have improved the state of affairs in Alberta. It also maintains a commitment to some proposals that could do more harm than good depending on the details of their implementation.

On the other hand, it at least maintains one key proposal to depart from the status quo that will unquestionably improve the health-care program for all Albertans: a greater role for private health-care facilities. We can only hope that the government doesn’t again cave in to ideological opposition this time around.

One small step ahead is unquestionably better than nothing.

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