Are misconceptions and misunderstandings making Canadians blind to the possibilities of private healthcare?
Misinformation about the Canadian healthcare system is pervasive. And it may be preventing our much-needed positive health system change.
A recent decision by the courts in British Columbia prevented patients who were unable to get public sector care from accessing private healthcare insurance and private care. In its judgment, the court wrote that if private care was allowed to enter Canada, that private care and private health insurance would destroy the public system.
A study by the Fraser Institute details how Canada is one of the only countries in the world that does not embrace private insurers for medically necessary care. Importantly, each of the 16 countries examined in their report share Canada’s goal of ensuring universal access and insurance coverage for medically necessary care. Many of them have much shorter wait times than Canada, in part because of funding and capacity from their parallel private systems. As we know from other health systems around the world, the BC court’s decision seems to be based on a misguided notion and misinformation. We can look at other health systems from the Fraser Institute report to understand there are many different ways that this can, in fact, work.
The concept of ‘two-tier healthcare’ carries a very negative connotation in Canada’s health policy discourse, but other countries have been very successful using a combined private-public approach while ensuring universality and adhering to the principles of universal access to timely high-quality care.
Coverage in Germany is split between two entities: competing private not-for- profit sickness funds and private health insurance. Germans rely on about 118 of these competing sickness funds in combi- nation with 42 private insurance firms to provide coverage. All are closely regulated by the government to ensure that patients are treated fairly and equitably and in a timely manner.
Across the EU, in 25 European countries, universal healthcare, similar to Canada, includes a government-regulated network of private health insurance companies.
Australia provides universal coverage to all residents. However, unlike Canadians, Australians can purchase private health insurance that allows for faster access to non-emergency services and greater selection of healthcare providers, while still maintaining access to emergency services for all patients.
Australia made the decision in the 1970s that private dollars would fund private infrastructure to increase total healthcare capacity without negatively impacting the public system. It worked. The government started a not-for-profit health insurer, Medibank, which was successful and grew to cover about 30 per cent of the population. This meant that there was enough healthcare capacity to provide timely and high-quality care without excessive wait times.
In Israel, every resident must be a part of one of the country’s four official health organizations: Clalit, Leumit, Maccabi, or Meuhedet. These are not-for-profit organizations and Israel encourages competition amongst the four which enhances the ser- vice for patients. In addition, Israel allows residents to purchase private health insurance. Public and private co-exist to create a highly ranked healthcare system.
- Misinformation about Private Healthcare in Canada:
Those who oppose private healthcare in Canada posit that it does not exist in Canada and has no place in our public universal Canadian healthcare system. In reality, much of our public universal Canadian healthcare system is already private. Aside from the obvious services that have been deemed ‘non-essential’ by provincial governments who have the freedom to make those decisions (e.g., dental care, rehabilitation services, certain medications, etc.), hospitals are private companies with con- tracts from the government to deliver care. Additionally, private services can be purchased in Canada, just not by individuals.
Companies are able to purchase a surgery, for example, for an executive employee on their behalf.
And along the same lines, you can purchase private health insurance in Canada. These policies can provide millions of dollars of coverage for any healthcare condition. The only problem is that you can’t get the services in Canada. You can buy the insurance in Canada, but you would have to go to the U.S. for the healthcare services. People in Canada are going ahead and procuring private services, they’re just giving the funds to another healthcare system.
- Misinformation about Doctors Abandoning the Public System:
A major argument made by those opposed to the consideration of a parallel private system in Canada is the concern that most doctors and nurses would abandon the public system for the private system. This is a fair concern and one that could be regulated by the government. In other healthcare systems, such as in the United Kingdom and Australia, government entities regulate the amount of time doctors can spend in the private systems, keeping the public system adequately populated by doctors and access to equally quality care accessible to all.
- Misunderstanding That Healthcare Is ‘Free’ in Canada:
As of 2021, the total per capita expenditure in Canada for healthcare was estimated to be about $8,019. This is an increase from the previous years and a significant increase from the 1970s, just prior to the implementation of the 1984 Canadian Health Act. (Statista Research Reports). And healthcare inflation usually leads the inflation rate in the general economy because the usual price mechanisms and competition do not operate in healthcare in Canada.
Nationally, last year governments in Canada spent $300 billion, with annual spending increasing unsustainably faster than the national economic growth rate. We, Canadian taxpayers, pay for healthcare.
- A Single Healthcare System Prevents Inequity:
Having a single public system does not guarantee equity, nor does it prevent inequity. Many Canadians with the available funds already travel to the United States for care. Canada’s vast geography also greatly impacts health access and equity. Canada has an unequal distribution of healthcare resources. If you look at healthcare out- comes in small rural areas, they are worse than they are in urban centres. Furthermore, those with power, position, and influence can get access to care within Canada on an expedited basis. And public healthcare systems are plagued by systemic racism, often alienating and mistreating many of those in society who need care the most.
- Canada’s Healthcare System Is Ranked Almost Highest in the World:
The Commonwealth Fund’s 2021 report released in August, compared 11 high income countries. Canada was in 10th place, ahead of the United States, which was at the very bottom. While Canadians are lucky to have access to the care we do, it is not accurate to think we are ‘the best in the world.’
As you can see, misinformation and misunderstandings and faulty assumptions which are blindly and unashamedly broad- cast widely are supporting the continuation of our broken, but fixable, healthcare system. It is becoming obvious however to most, that big changes are desperately needed and hopefully soon.
Raymond Rupert is the CEO of RCM Health Consultancy, Inc.