Canada in race with US for worst healthcare system

By on August 8, 2014

The latest Commonwealth Study ranked Canada’s healthcare system a dismal second to last in a list of 11 major industrialized countries – beating out only the Americans.

This latest poor result is already being used by those bent on further privatizing healthcare. They argue – as they always do – that if Canada only allowed more private finance, wait times would melt, emergency rooms would unclog and doctors, nurses, patients and the public would all be better off.

They are wrong.

For starters, what most of those calling for more private financing don’t understand is that we already have a mix of public and private care. In fact, Canadians have their health needs covered by the public system only 70 per cent of the time, much less than the UK (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?

First, our health system fails to offer universal (public) coverage for prescription drugs, unlike that provided in nearly every other developed country in the world. Second, Canada also has inadequate coverage for home care and long-term care, which are more comprehensively offered 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 and 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.

The strength of Canada’s healthcare system is its 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.

But instead of moving to adopt the policies of better performing systems, Canada may in fact be taking a step backwards.

Our commitment to restrict private finance is being threatened with by a legal challenge initiated by a private clinic in B.C, set to go to trial in September. If it wins even more private financing will be introduced to Canada’s health system (with some pretty clear vested interests profiting from the outcome), moving it one step closer to the worst performing health system among developed countries: the United States.

Doctors would then be able to (extra) bill patients whatever they wish, on top of what payment they already receive from the government for specific health services. Those patients who can afford it will be able to buy private health insurance to defray the costs of such extra-billing.

Instead of competing with the United States for last place, we need to start addressing the real issues that plague our healthcare system. A good place to look for solutions would be to look at the expansive – and better performing – policies of European systems, beginning with a universal health system that includes drug coverage, home care and long-term care.

This may seem counter-intuitive when the problem plaguing our public system is always portrayed as a lack of money, but we know, as in business, that sometimes you have to spend money now to save money later. We must also look at providing incentives throughout our public and private sectors in the healthcare system to ensure that the right care is delivered to the right people in a timely way.

There is no doubt that, if the constitutional challenge is successful in British Columbia, the problems we see in the Canadian health system – fragmentation, lack of coordination, 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?  -TroyMedia

 

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.

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