Fraser Forum

When Canada's public health-care system fails, what options do patients have?

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It’s a difficult thing for Canadians to admit, but it’s all too clear that our health-care system is in trouble.

Despite ranking among the highest spenders on health care, Canada has fewer physicians, beds and diagnostic imaging scanners than most countries in the OECD. And some of the longest wait times for medically necessary care in the developed world.

What’s particularly concerning, however, is that most of the 894,449 patients who waited an average 18.3 weeks for treatment last year have no recourse other than to cross the border to seek treatment elsewhere. Indeed, it’s estimated that in 2014 about 52,000 Canadians did just that.

That we’ve set up a system that forces patients to endure these long wait times without fully considering the consequences is not just remarkable, but shameful. Loss of income, worry, stress, anxiety, pain and difficulties with daily activities are just some of the well-documented repercussions of lengthy wait times. Research also indicates that protracted wait times can result in potentially treatable illnesses and injuries becoming chronic, permanent, debilitating conditions. In the worst cases, they can even result in death.

It’s precisely for this reason that Dr. Brian Day, former head of the Canadian Medical Association, is fighting a court case in British Columbia to allow private treatment for patients who have been failed by the public system.

While many may be ideologically opposed to this notion, they should consider two facts. First, this is not a crusade against the universal nature of our health-care system, but rather a bid to enable doctors to better deliver on the promise of universally accessible care. Under the current system, hospitals generally have to remain within their bureaucratically defined budgets and restrict the number of patients being treated even if operating rooms in the facility are available. Further, physicians in the public system are not allowed to provide additional treatment outside of the public system even if they have the time and patients are willing to pay. This means that precious resources and are being potentially left idle, while patients languish in the queue.

Second, a glance at other universal health-care systems clearly reveals that the involvement of private insurers and hospitals (either as a partner, or an alternative) is actually the norm. For example, for-profit companies compete to offer primary health-care insurance in the Netherlands, offer a private substitute for public health-care insurance in Germany, and offer a private option alongside the public system for patients in Australia and Sweden.

Private for-profit hospitals are even more commonplace in countries with universal health-care systems.

For example, in Switzerland 51 per cent of hospitals were categorized as for-profit institutions in 2012. In Germany that percentage is 42, in France it’s 40 per cent, and in Australia it’s 35 per cent. Even in Sweden, three of the country’s 83 hospitals are for-profit institutions, including a large acute-care facility that delivers services to patients within the public system.

Notably, in all of these countries (and many more) patients can pay for treatment if they choose to do so—and this freedom has had no impact on their fundamentally universal nature.

For years we’ve been presented with a false choice—public or private—whereas most universal health-care systems have long ago understood that the best way to deliver universal health care is a mixture of public and private.

We have to ask ourselves one question—if we prevent patients from seeking private care when the public system fails them, then what option are we leaving them with?


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