Tommy Douglas on Universal Health Care (Requires Windows Media Player)
(I can only get it to work in Internet Explorer so far)
Canada spends a lot of money on health care... period. In the 2007-2008 provincial budget, health care clocked in at an estimated 41% of total expenses. Total health care spending in Canada – approximately 10% of total GDP – is on average comparable to what other OECD countries spend on health care; however Canada’s percentage of public spending (roughly 70%), is somewhat above the international median.
In previous blogs I have discussed some of the factors that are currently putting strain on our health care system, introduced the debate around privatization and universal health care, and talked about four idealized health care models and how different countries around the world fund and deliver health care.
In 2005 the Supreme Court of Canada struck down a Quebec law that prevented people from purchasing private health insurance to pay for services already being delivered through the publicly funded system. The two appellants contended that the Quebec law violated section 7 of the Canadian Charter of Rights and Freedoms as well as section 1 of the Quebec Charter of Human Rights and Freedoms. Justice Beverley McLachlin and Justice John Major wrote in their decision “access to a waiting list is not access to health care.” Although the ruling applied only to Quebec, it served to open up the door for national dialogue regarding how health care should be delivered.
Dr. Brian Day, the recently appointed president of the Canadian Medical Association (and owner of a privately run surgery centre), believes that private-sector-style discipline is the cure for what ails Canada’s health care system. Hospitals currently receive most of their public funding via annual grants and transfers. Day would like to see funding for hospitals moved to a fee-for-service basis – just as it is for GP’s – so that there is incentive for hospitals to be more efficient, and treat more patients. He would also like to see changes to the Canada Health Act affording privately owned clinics the ability to compete for the right to provide medical services, which would still be funded by the public purse. Day’s vision is therefore to increase private delivery of services, but still maintain public funding.
Dr. Arnold Relman, who appeared before the senate committee on health care, argues that health care is fundamentally different from most market-based goods and services, and it is dangerous to treat sick patients like consumers. Other critics of Dr. Day argue that moving hospitals to a fee-for-service basis gives them incentive only to increase quantity of treatments and not quality of treatment. Hospitals will focus on the quick procedures that make healthy profits, while ignoring the procedures which are complex and expensive.
To me, Dr. Day’s vision of incentive based funding seems like a reasonable way to reduce wait times, and make our current health care system more efficient. The problems that his critics mention could potentially be resolved with regulations forcing hospitals to perform all types of treatments and not just the quick and cheap ones (of course this would add some administrative expenses). Alternatively, hospitals could be entitled to bill the public system at higher rates for performing complex and costly procedures so as to ensure they have sufficient incentive to perform all kinds of necessary procedures.
No one pretends that the question is as simple as a ‘yes’ or ‘no’ on private health care. The fact is that private health care in Canada already makes up a large part of the system, and to some degree anyways, is likely here to stay. What makes studying this topic so difficult is the unending complexity of variables that contribute to overall health and wellbeing, and to the success of a given health care system. We can’t simply look to other countries and say because they allow private clinics and because they have better population health indicators than Canada, their health care system is better and we should therefore adopt their model. Even within Canada, there exists great variability in the challenges to providing health care in different regions and to different groups of citizens.
With wait times in some areas becoming dangerously unreasonable, there is increasing tension between the Canada Health Act and the Charter of Rights and Freedoms. In the conclusion of my blog on privatization of health care I will be discussing major studies recently undertaken on behalf of the government, analyzing the results of those studies in terms of what steps governments have taken, and looking briefly into the future of health care in Canada.
Sources:
Health Canada: Overview of the Canada Health Act
CBCNEWS INDEPTH: Health Care
Financial Post: Don’t Take a Number
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