Spending More for Less

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Appeared in the Prince Albert Daily Herald, 08 November 2006
According to new forecasts by the Canadian Institute for Health Information, Canada’s provincial governments will spend a cool $96 billion on health care this year (2006/07). That level of spending is a high water mark for Canada and an increase of 5.7 per cent from last year (2005/06). While the level of spending is important, the more critical issue is whether Canadians are getting good value for all that money.

The latest figures on hospital wait times suggest not. In fact, the wait time for an average Canadian was slightly higher in 2006 than it was in 2005 – 17.8 weeks vs. 17.7 from referral by a general practitioner to treatment. That wait time is the second longest Canadians have ever experienced--the longest being 17.9 weeks in 2004--and is not far from double that experienced in 1993. In addition, the available evidence suggests that wait times in Canada are among the longest in the developed world.

The latest comparisons of access to physicians and technology between Canada and the other developed nations that also guarantee access to health care regardless of ability to pay also suggest Canadians are receiving poor value for their money. In the most recent year for which comparable age-adjusted data are available, Canada ranked 24th among 27 nations (for whom data was available) in the number of physicians per capita, 13th of 22 in MRI machines per capita, 17th of 21 in CT scanners per capita, 7th of 12 in mammographs per capita, and last of 16 nations in lithotripters per capita. Put simply, $96 billion did not buy top ranking access to physicians or technology either.

Of course, some might suggest that if we want first-class health care we’ve got to spend even more. But in the most recent year for which comparable age-adjusted data are available, Canadians actually spent more on health care in total (public and private) than 25 of the 27 other nations that have universal access health care programs. Only Switzerland and Iceland outspent Canada. Recent trends suggest no change in this top-ranked spending performance.

So what happened? How is it that health spending in Canada outpaces that in most other developed nations that, like Canada, guarantee access to care regardless of ability to pay and yet access to health care in this country lags behind that available in most of these other nations? The answer to this question lies in the health care polices pursued by provincial governments across Canada. These policies are forced upon them by the federal government through the Canada Health Act (CHA) and the threat of loss of sizable cash transfers should a province not abide by its myriad rules, regulations, and federal interpretations.

Of the 27 other health care models in the developed world offering universal access to care, several countries 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.

Each of these countries requires that patients share some of the costs of health care--a policy specifically forbidden by the rules and regulations of the CHA. According to research and international evidence, when patients are responsible for some of the cost of their care, they use fewer resources (making more available for other patients and saving money overall) and end up no worse off in terms of health outcomes as long as low income populations are exempted.

These countries also allow private providers to deliver publicly funded health care--a policy often strongly discouraged by various parties’ interpretations of the Act. Both economic research and international evidence have shown that competitive private provision of services is more cost-efficient and produces a higher quality of care than the monopolistic public provision of services that exists in Canada.

Though Alberta and BC have indeed contracted some surgeries to private providers, neither has allowed fully private operation of an acute care hospital nor encouraged open competition in the delivery of surgical or hospital services.

Finally, none of these countries has outlawed an individual’s right to contract privately for their own care--a freedom prohibited by current interpretations of the CHA 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 universal access health care system. Patients everywhere else in the developed world are free to seek care on their own terms if they so desire.

The evidence clearly demonstrates that Canadians are paying more for health care while getting less in return. We can only hope that Canada’s governments and their successors will finally understand that competition and appropriate financial incentives for both patients and providers will significantly improve the lives of Canadians. The current health care model simply does not deliver to Canadians the care they should expect for the amount of money their governments are spending.

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