Ambulances parked by the emergency department at Toronto Western Hospital, on July 14.Fred Lum/the Globe and Mail
Of all the things that Ontario Premier Doug Ford has said about the health care crisis in this country, perhaps the most perceptive – and obvious – is that what we’re doing is failing Canadians.
“The status quo is not working, folks,” Mr. Ford recently said at a stop in New Brunswick, where he was rallying premiers in the four Atlantic provinces to press Ottawa for more funding. He’s been banging on this drum for weeks now, as he markets Ontario’s plans to shake things up in the health care system, including the ways some services are delivered. “We need to be creative.”
Certainly, “creative” is not a word generally associated with health care in Canada. The solution for every problem that has existed has always been more money, rather than looking at root causes or whether there was another way of doing things more efficiently. We have refused to shatter any sacred cows.
That discussion has been almost impossible to have because it inevitably raises the spectre of the biggest health care bogeyman of them all: privatization. And that debate always seems to circle back to the United States. Privatization, its critics say, would lead to the gross inequities that we see in the health care system down south.
Nonsense.
As my colleague André Picard and others have pointed out, privatized health care exists virtually around the world – including in countries deemed to have systems far superior to our own, and even in communist and socialist countries.
For years, CEOWORLD magazine has been putting out a Health Care Index, which ranks 89 countries against factors that contribute to a person’s overall health. It looks at the system’s infrastructure, the number of doctors, nurses and other health workers, general costs and efficiency, among other things.
Any discussion about health care reform is loaded with “whataboutisms.” Point to a lauded country that has some privately delivered services, and someone will alert you to health care outcomes there that aren’t so great. And it is true that there is no perfect system, anywhere. But the countries on the magazine’s 2021 list are often included in other rankings of the world’s top health care systems: South Korea led the pack, followed by Taiwan, Denmark, Austria, Japan, Australia, France, Spain, Belgium and the United Kingdom.
Canada ranked 23rd.
When you start looking into what the top-ranked countries are doing, one thing catches your attention: In almost every case, the private sector has at least some role to play.
South Korea, for instance, has universal health care, but 77 per cent of the population has private insurance; the national plan only covers 60 per cent of a person’s health care bill. In Taiwan, public and private providers compete for payments from the national health care insurance system.
Denmark has optional private health care, although the uptake is small. The same is true in Austria, although if you go to a private health care provider, you can get up to 80 per cent of your costs covered by the national plan. In Japan, most people have private insurance, but the government pays about 70 per cent of a person’s medical costs.
Australia offers a private option which gives a person the right to choose their doctor and the hospital in which they want to be treated. And France allows optional private insurance under the country’s universal coverage, aimed at those who want services not covered by the government, such as visits to psychologists or osteopaths.
Yes, access to private health care can produce inequities in some countries. In Spain, private health care allows patients to avoid lengthy waits often found in the state system. In Belgium, private health care operates alongside the public system, and doctors are allowed to work in both. In the U.K., you can get private insurance that opens the door to reduced wait times, private rooms and preferred doctors or hospitals. But many of those same problems already exist in this country too, and likely always will.
Today, Canada’s health care system is universal in name only. It was designed to ensure no one was denied essential services because of an inability to pay, but as we have become keenly aware, people are being denied essential services every day, even among the poor and working class.
Doug Ford is right: The status quo is not working. It’s time to start experimenting with models of health that blend public and private delivery. With 10 provinces and three territories in our federation, we have the perfect country in which to experiment with some of this stuff to see how some of it works – or if it even works at all.
The biggest deterrent to the change we need is the short-sightedness of any discussion around it.
Gary Mason