Erik Johnson is an insurance executive and Canadian living in Britain.
Health care is currently top of mind for many Canadians, given recent concerns that our system is in crisis, demands for more government spending, and staff and facility shortages. Rather than retreat to the mantra that “public health care is always best,” we should consider European and Australian evidence on how a mixed funding and delivery model can reduce health care costs, increase accessibility, and result in better patient outcomes.
Provinces such as Ontario and Saskatchewan are already making moves to leverage private health services, and more can be done. Let’s start by considering a potential scenario that would leverage private care for orthopedic surgery in Alberta.
Imagine a hypothetical situation in Calgary in which there is demand for 5,000 new hips a year and there are four hip surgeons. Each surgeon is allocated operating-room time to perform three replacements a day because of Alberta Health Services budget constraints, equating to 3,120 surgeries a year. This leaves 1,880 patients waiting for a hip at the start of the following year, when another 5,000 join the queue.
Now, imagine Alberta allows the construction of a privately funded and operated specialized hip-replacement facility in Calgary. The facility is jointly owned by three orthopedic surgeons who graduated in Canada but struggled to find work here (the Canadian Orthopaedic Association found that nearly 100 recent graduates over the past six years could not find full-time employment or moved outside the country for work) and the reputable U.S. non-profit health care provider Kaiser Permanente.
By hiring underemployed medical professionals, the Calgary facility helps stem the tide of them going to the United States and keeps our taxpayer-funded training investments in Canada. Albertans now have access to a facility built with no public money.
Then imagine that Alberta passes legislation allowing the purchase of private health care insurance that kicks in once a person waits more than six weeks for care. The insurance conglomerate Axa offers a product like this in Britain for $60 a month, which includes cancer and psychiatric treatment.
The private health insurance market in Alberta would be strictly regulated by a provincial body in terms of price, accessibility and quality. Albertans who purchase this insurance would now have access to care when the public system fails to provide them with timely care.
At the same time, the government regulations could mandate that for every 10 private surgeries, the private facility must perform three publicly funded surgeries that cost 10 per cent less than the public system. Because the facility operates six days a week and has a capacity for four surgeries a day per surgeon, driven by efficiencies through specialization in hips only, it performs 3,744 surgeries a year, including 864 for public Alberta Health Services patients.
Regulations also require the facility to be responsible for the costs of patient care from initial consultation to final discharge from the surgeon’s care, usually one year after the operation. This means the public system does not pick up the cost of complications, and the rules incentivize the private facility to efficiently provide the full suite of high-quality care Albertans deserve.
In this model, Calgary has an annual demand of 5,000 new hips, with a capacity of 6,864 surgeries, meaning a surplus of 1,864. Calgarians will no longer suffer long waits for hip replacements, and Calgary surgeons can take on other public or private patients in Alberta, or even become a medical tourism destination for patients from other provinces or the U.S.
I struggle to see how this model undermines the public system or diverts resources from it, particularly given the current system does not use available resources to the fullest (e.g. unemployed surgeons). But it recognizes that the public system is constrained, a monopoly payer-and-provider system has to ration care, and there are other public-private health care models apart from the dreaded American-style system.
Looking at some health care models that offer universal care at a cost per person similar to Canada’s, clearly there are things we can learn. For example, in the Netherlands, 97 per cent of patients get emergency care within four hours, versus 70 per cent of Canadians. In Australia, 66 per cent of patients were able to get same-day or next-day doctor’s appointments, versus 41 per cent in Canada. What is universally different among these models is that they don’t ban private care or private health insurance.
Imagining possible solutions at a time when government finances are under pressure and health care demands from an aging society are increasing is paramount. With thoughtful regulation, Canada can develop a third way in health care, bring its model much more closely in line with those in Europe, and improve access to care.
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