Setting the Record Straight on Private Health Care

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posted August 28, 2006
The results of several votes at the Canadian Medical Association’s annual meeting last week -- including votes to install Dr. Brian Day as President-Elect and to support a greater role for private health care provision and financing in Canada -- created a furore in Canada.

Those opposed to a greater role for the private sector issued dire warnings against moving towards any health care model that includes private parallel health care providers and insurers or private delivery of publicly funded services, claiming that such changes will only worsen the state of health care in Canada.

So that we can make an informed decision about how to improve Medicare, Canadians must face the reality of health care in Canada today and get the facts about the contribution private competition can make toward improving Medicare.

There is little debate about the current state of Canada’s Medicare system. Of the 28 most developed countries that guarantee access to comprehensive health care insurance regardless of ability to pay, Canada ranks third and only slightly behind Switzerland for age-adjusted expenditures on health care. Despite that high level of expenditure, Canada manages to rank near the bottom in terms of 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.

While the solution to Canada’s Medicare woes will require numerous changes, one of the most critical components is the introduction of competition from the private sector.

First off, Canadians must understand that the a greater use of the private sector is not a move away from the underlying principle of Canada’s health care system - guaranteed access for all regardless of ability to pay. Consider that every other developed nation that has a universal health insurance program also allows the privately funded delivery of medically necessary services. The majority of developed nations with universal programs also allow private providers to deliver universally available/publicly funded health care.

Those countries that have allowed the private sector a greater role in health care have enjoyed more efficient and effective health care programs. Seven of these developed nations have no waiting lists for medically necessary care: Austria, Belgium, France, Germany, Japan, Luxembourg, and Switzerland. Three of these developed nations outperform Canada on measures on health system performance: Australia, Japan, and Sweden. In all of these nations, individuals reserve the right to seek care on their own terms through a parallel private sector when the public program is unwilling or unable to meet their needs.

With regard to the delivery of universally accessible services, in those countries where waiting lists are insignificant, private providers openly compete for the delivery of publicly funded care. In Sweden and Australia private providers have contracted with some regional governments to provide care for patients. Most important for Canadians is the fact that the introduction of privately owned hospitals and a more competitive hospital sector in Sweden (away from a model similar to Canada’s) led to more cost-efficient delivery of services and to a reduction in waiting times for patients receiving publicly funded care.

Obviously, the statements that private health insurance can only lengthen wait times, and that private providers of public care do not improve the state of affairs have not held true in these nations. Such statements have also not held true elsewhere in the developed world. 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.

Claims that Canada’s situation is unique because of the limited supply of physicians (a parallel private health sector might increase wait times because physicians will be drawn away from the delivery of publicly funded services) are also misleading. Such claims rely on the assumption that Canadian physicians are unable to provide more services than they currently deliver through the public program, which is simply not true.

The reality is that despite the relative lack of physicians in Canada, many Canadian physicians spend a good deal of their time waiting for access to operating rooms or are unable to treat patients because of provincial quotas and limits. In other words, there are idle physician resources in Canada that the public system is simply unable or unwilling to employ. Thus, a system that permitted these physicians to practice in both the public and private parallel sectors would not rob the public system of resources but would instead increase the number of resources available to Canadians in total.

While Canadians have been hearing a great deal of negative rhetoric about private health providers and parallel insurance following the CMA’s annual meeting, the evidence shows that the introduction of both would improve the state of affairs in Canada for all individuals in need of health care, regardless of their ability to pay. Though there are other reforms necessary to emulate the success of the world’s most effective and efficient universal access health care programs—notably the introduction of cost sharing for publicly funded services—a greater role for the private sector in Medicare is a step in the right direction.

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