Dr. Colleen M. Flood is an expert advisor with EvidenceNetwork.ca and a professor in the Faculty of Law, the School of Public Policy & Governance, and the Institute of Health Policy Management & Evaluation University of Toronto.
The latest Commonwealth Study ranked Canada’s health care system a dismal second to last in a list of eleven major industrialized countries. We had the dubious distinction of beating out only the Americans. This latest poor result is already being used by those bent on further privatizing health care. They argue – as they always do – that if only Canada allowed more private finance, wait times would melt, emergency rooms would unclog and doctors, nurses, patients and the public would all be, if not quite utopia, then at least better off than now.
It is true that Canada’s health system is fragmented and unco-ordinated. Too often people fall through the cracks and we are miserable at managing patients with multiple illnesses. And too often our system feels unresponsive to the concerns of patients and their families. The average Canadian could be forgiven for thinking that there may be something to all of these calls for private finance. But they would be wrong.
For starters, what most commentators weighing in on the health debate don’t understand is that we already have a mix of public and private care. What distinguishes Canada’s health system from others is not how little private finance we have but how much private finance we already endure. Canadians have their health needs covered by the public system only 70 per cent of the time, much less than the U.K. (84 per cent) or Norway (85 per cent) or even France (77 per cent).
Indeed, Canadians actually hold more private health insurance than Americans do. How is this possible?
Our health system fails to offer universal (public) coverage for prescription drugs, unlike the coverage provided in nearly every other developed country in the world. Canada also has inadequate coverage for home care and long term care, which are more comprehensively covered in many other health systems, such as Japan, Germany, Belgium and Sweden.
Unfortunately, our health system is more like the U.S. system than most of us know. Just like the U.S., our approach to prescription drugs, home and long-term care is to have some people covered through private health insurance via their employer, some people covered by governments because they are on welfare or elderly, and a big chunk of the population going without.
Our system is also similar to the U.S. – and dissimilar to many other countries that out-perform us on health indicators – by paying physicians on a fee-for-service basis, meaning doctors are free to work as many or as few hours as they wish, whenever they wish and wherever they wish regardless of the needs of patients.
Instead of moving to adopt the policies of better performing systems, Canada may be taking a step backwards. A constitutional challenge is going to trial in British Columbia in September and the private health clinic bringing that challenge is set on introducing even more private finance to Canada’s health system. If it wins, doctors will be able to bill patients whatever they wish on top of what payment doctors already receive from the government for specific health services (extra-billing). Those patients who can afford it will be able to buy private health insurance to defray the costs of such extra-billing.
So what’s the problem? This would move the Canadian health system one step closer to the worst performing health system among developed countries: the United States.
The jewel of Canada’s health care system is the commitment to restrict private finance for medically necessary hospital and physician care. We don’t let our doctors double dip, and we keep essential health services available to all, regardless of means. Yet it is this commitment that is being threatened with the legal challenge in B.C., and blamed for the problems that have beset Canada’s health system – with some pretty clear vested interests ready to profit from the outcome.
Instead of having Canada’s health system compete with the United States for last place, we need to start addressing the real issues that plague our system. We could start by looking at the expansive policies of European systems that perform better than our own, starting with a universal health system that includes drug coverage, home care and long-term care.
This may seem counter-intuitive when the problem is always portrayed as a lack of money for the public system – but we know in business that sometimes you have to spend money now to save money later. And we must look at providing incentives throughout our public and private sectors in the health care system to ensure that the right care is delivered to the right people in a timely way.
If the constitutional challenge is successful in British Columbia, there is no doubt that the problems we see in the Canadian health system – fragmentation, lack of co-ordination, lack of access to important kinds of care and wait times for those without private means – will worsen. Why would we want to race to the bottom of the pack?