Private sector plays important role in other universal health-care countries

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Appeared in the National Post, November 25, 2015

For years, the Canadian public has been presented with two distinct health policy options by pundits, politicians, and other defenders of the status quo. On the one hand, we are told we can have a universal health-care system dominated by government. The alternative, we’re told, is a system where private for-profit insurers and hospitals are present but universality is unattainable.

This simply isn’t true and ignores the reality of multiple universal health-care countries.

The noble goal of universal-access health care is not unique to Canada. Rather, it’s a goal we share with nearly every other developed country, all of which pursue it through a combination of government, private non-profit and for-profit institutions. Consider the examples of Australia, France, Germany, the Netherlands, Sweden and Switzerland, each of which delivers higher quality universal health care for similar or lower costs than Canada. Unlike Canada, these countries do not appear to be frozen by a fear of profit-making, and rather seem to have embraced it as part of their higher-performing approach to universality.

In all of these countries, private for-profit insurers compete in the voluntary insurance sector, variously offering services such as expanded choice of physician and hospital, private rooms, coverage for vision and dental, and expedited access for elective treatment and day surgeries. What may come as a surprise to some readers is that for-profit companies also compete to offer primary universal health-care insurance in the Netherlands, and compete to offer a substitute for public-health insurance in Germany. In these countries, co-operation between private and public systems is aided by the ability of doctors to practice in both the public and private systems, and accept payments from either insurer.

The presence of for-profit hospitals is even more commonplace. In 2012, some 42 per cent of hospitals in Germany were for-profit institutions, as were more than half of hospitals in Switzerland, and about 40 per cent of hospitals in France. Nearly all of these for-profit hospitals provide care for the universal systems of each country. In Australia, 35 per cent of hospitals are for-profit facilities with some contracted to provide universally accessible care. Even in Sweden, three of the country’s 83 hospitals are for-profit including a large acute-care facility that delivers care to patients within the universal system.

This level of cooperation between public funders and for-profit institutions is ostensibly absent in Canada. Private for-profit parallel insurance is disallowed, dual-practice of physicians is prohibited in most provinces, and only a small number of for-profit clinics and hospitals can be found in a climate that does not encourage their formation.

Some pundits say such involvement of the private sector (for-profit institutions in particular) is antithetical to the goal of universal-access health care. Others in Canada argue more strongly that any involvement of the private sector, especially the for-profits, will sacrifice the universal nature of our health-care system. None apparently have bothered to look at what other countries, particularly those with high-performing universal access health-care systems, are doing.

While Canada struggles with long wait times, physician and medical-technology shortages, and health-care expenditures that are eating away into provincial budgets, pundits and policymakers are taking valuable policy options off the table for philosophical reasons.

The experience of other countries demonstrates how the private sector can play an important role in helping deliver on the promise of universal-access health care. We owe it to patients to consider all options that have demonstrated an ability to deliver universal, high-quality health care.