Last month, on the heels of a new threat from the British Columbia government to fine doctors who accept private payment for treatment already covered by the government-run health-care system, a trial – initiated more than seven years ago by a private Vancouver clinic led by Dr. Brian Day – resumed.
Day, a former head of the Canadian Medical Association, is fighting to allow privately-funded treatment for patients who the public system has failed.
Just a few days later, data from the Canadian Institute of Health Information (CIHI) reported that about one-third of patients in B.C. did not receive joint replacements and cataract surgeries within the remarkably long government benchmarks. And it’s getting worse.
These events have again raised the contentious topic of patient cost-sharing and the appropriate role of the private sector within, and alongside, a universal health-care system.
Unfortunately, defenders of the status quo have misled Canadians into believing that to maintain universal health care, patients should neither expect to share in the cost of their treatment nor use their financial resources to access treatment outside the public system.
And yet a glance around the world reveals that private-sector options and cost-sharing are norms, not exceptions, in successful universal health-care countries.
A recent Fraser Institute study compared Canada’s approach to universal health care with systems in Australia, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland and the United Kingdom. Each of these countries share the same goal of universal access to care, spend about same as Canada (some more, some less) but have remarkably shorter wait times.
And most of these countries embrace the private sector as a fundamental part of their universal health-care framework. In the Netherlands, for example, individuals are expected to purchase health insurance from private (including for-profit) insurers in a regulated but competitive market.
More than one-third of hospitals in Germany operate on a for-profit basis but are generally also accessible by patients with public insurance.
Even the U.K. has a robust parallel private system, often used as an alternative to the ailing public National Health Service (NHS). In fact, Prince Philip recently received a hip replacement at a private facility and questions have been raised about whether the NHS, which has long waiting lists, would have even treated someone his age.
All these countries except the U.K. accept cost-sharing as a normal part of universal health care. Cost-sharing establishes the right incentives to ensure patients make more informed decisions about when and where to use scarce medical resources.
Patients in Switzerland can expect to pay the first 300 franc (equal to roughly C$390) of their medical bills before insurance kicks in – and 10 per cent of the cost of their treatment, up to a maximum of 700 franc per year.
In Australia, although much was made of the government’s recent see-saw on the question of a $7 fee for general practitioner visits, patients can still expect to pay about 15 per cent of the cost of specialist visits (sometimes more, if doctors charge above the government rate).
Of course, all the countries examined protect vulnerable groups, and therefore either exempt certain populations from payments (children, mothers), provide a government safety net or set annual ceilings on out-of-pocket expenses.
Only in Canada are doctors threatened with fines for looking after patients privately and outside of the government-funded system, while patients are made to feel guilty for paying for their own treatment. In no other successful universal health-care system does government step between doctor and patient, and forbid doctors from providing medically necessary treatment.
Of course, if our governments provided timely access to care, patients would be less inclined to pay for treatment. However, that’s not the case. Data from the Fraser Institute’s annual survey of wait times reveal that patients are waiting longer than ever.
Until governments in Canada realize that the private sector and patient cost-sharing are a normal part of universal health care, Canadians will likely continue to wait for the treatment they need within the confines of the only system available.
Bacchus Barua is associate director of the Fraser Institute’s Centre for Health Policy Studies.
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