To retain the promise of universal health care that Canadians cherish, we must change the way we attempt to deliver it
Whether you ask physicians or patients, the answer is the same – Canada is failing to provide timely access to medical care.
The U.S.-based Commonwealth Fund, in conjunction with the Canadian Institute of Health Information, just published the results of their health policy survey of adults in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States. The results indicate that Canada is not just lagging, but is literally scraping the bottom when it comes to indicators of timely access to health care.
Here’s a sample of our most spectacular failures:
- Ability to get a same or next-day appointment when sick: worst
- Ability to get after-hours care (without resorting to visiting an emergency department): second-worst
- Wait for treatment in the emergency department: worst
- Wait to see a specialist: worst
- Wait for elective surgery: worst
Of course, the fact that Canadians face significant wait times for treatment will not surprise anyone familiar with the Fraser Institute’s annual wait times survey. Last year physicians reported that their patients waited longer, on average, than they ever had in the survey’s 26-year history. Importantly, they also reported that patients are waiting longer than what they (the physicians) consider to be clinically reasonable.
While Canadian patients suffer the reality of long delays, which may lead to deteriorating and irreversible harm, apologists claim wait times remain a small price to pay for universal health care. But that’s wrong – a quick glance at the countries included in the Commonwealth Fund’s survey reveals that Canada’s failure is not intrinsic to universal health care.
Every country examined (except, some would argue, the U.S.) has a universal health-care system that ensures access to treatment regardless of ability to pay. They just do it differently. Most of these countries generally allow the private sector to provide core health-care insurance and services, require patients to share in the cost of treatment, and fund hospitals based on activity (rather than the global budgets that are the norm in Canada).
In the Netherlands, the top performer in-terms of ability to get a same/next day appoint and after hours care, individuals must purchase a standard insurance package from private insurers in a regulated, but competitive, market. A for-profit company is the market leader.
In France, the top performer in terms of wait times in the emergency department, universally accessible hospital care is delivered by public, not-for-profit and for-profit hospitals. In fact, about one-third of all hospitals in the country operate on a for-profit basis.
Switzerland, the top performer in terms of wait times to see a specialist, ensures universality in an environment of managed competition among insurance companies and providers of health care. Like most other countries, cost-sharing is a central feature of the Swiss system. Individuals are expected to pay a deductible before insurance kicks-in, after which a 10-20 per cent co-insurance rate applies up to an annual maximum, after which all expenses are covered.
In Germany, the top performer in terms of wait times for elective surgery, individuals can generally use social/statutory (SHI) or private (PHI) insurance to access public or private hospital care. Although 42 per cent of all hospitals operate on a for-profit basis, almost all hospital beds in the country are accessible to patients with SHI-coverage.
Whether it’s the Commonwealth Fund most recent report or the Fraser Institute’s annual wait times survey, the evidence is clear. Canadian’s wait far too long for treatment – compared to 26 years ago, compared to what doctors consider reasonable, and compared to other countries with universal health care.
It’s time to fix the system. To retain the promise of universal health care that Canadians cherish, we must change the way we attempt to deliver it.
By Bacchus Barua
Bacchus Barua is an economist at the Fraser Institute.