Here’s a little thought quiz to start your week. Which of the following characteristics come to mind when you hear the term monopoly service: efficient, customer-oriented, innovative, high quality, low cost?
If you answered “none of the above”, you probably recall the days when hooking up your telephone, sending a package, or even travelling by air offered few or no choices. Today, we have a wide variety of competing providers that offer higher quality service at a lower cost.
But in healthcare, by far the most important and costly service, Canada is the only country that forbids competing with the public system. A 2014 Commonwealth Fund Report found the performance of Canada’s monopoly healthcare system ranked well behind Australia, France, Germany, the Netherlands, New Zealand Norway, Sweden, Switzerland and the UK. And a 2013 Organization for Economic Cooperation and Development (OECD) report found that, despite spending 36 per cent more per capita than the OECD average, Canada has the longest wait times for elective surgery.
Recent Fraser Institute reports on the German and Dutch healthcare systems found that just 5 per cent suffered elective surgery wait times longer than four months, compared with 25 per cent in Canada. Those assessments also pinpoint the key reasons for this superior performance. Germany provides universal access to high quality, timely healthcare through statutory social health insurance, along with an option to buy supplemental insurance. Since Germany’s government monopoly healthcare system was replaced in 1991, the proportion of care delivered by private hospitals and clinics has risen to 70 per cent. The result has been higher quality care and shorter wait times at a lower cost. Private hospitals and clinics also play a dominant role in the Netherlands. The Dutch system offers universal coverage while allowing the public to select providers competing on the basis of quality and timelines of care.
The role of government is mainly funding and regulatory. The lesson here is that, as in virtually all other sectors, governments which try to be both the deliverer and the regulator fail to do either well.
That systems featuring competing private sector providers would prove superior to a bureaucratic government monopoly should come as no surprise. But that monopoly is also financially unsustainable. Ontario is this poster-boy for this stark reality. The 2012 government of Ontario-commissioned Drummond report projected that the cost of the province’s healthcare system, which already devours almost half of provincial spending, will rise to 80 per cent over the next two decades. The report states, “We challenge the government to open the door more widely for private sector involvement, not only to improve efficiencies, but also to capitalize on the huge economic potential in building a vibrant healthcare sector in Ontario”.
So what is that “economic potential”? A 2013 report commissioned by the Royal College of Physicians and Surgeons found that one out of six new medical specialists can’t find work, while many others accept roles far below their qualifications. Even long-established specialists are only working part time because of severe shortages of operating room access. Allowing these highly qualified professionals to fill those empty hours treating paying patients in private facilities would not only reduce public system waiting lists and costs, but also foster the establishment of Canada as a “go-to” country for fee-paying international patients. This represents a huge opportunity to enhance the sustainability of our public healthcare system, while creating a thriving private healthcare industry.
One would think such a compelling picture would have funding-stressed governments eager for change. But with the exception of Quebec, provinces have tried to stamp out the fragile green shoots of private patient care.
The fate of private healthcare will soon rest with the Justices on the Supreme Court of British Columbia. After the BC Medical Services Commission ordered him to stop collecting fees at his Vancouver private clinics, Dr. Brian Day launched a lawsuit on behalf of four of his patients claiming a Constitutional right to access timely private care. These patients had faced long waiting times that would have proven permanently debilitating or even fatal.
It’s astounding that Dr. Day and his patients should be forced to fight an expensive court case aimed at winning Canadians the same freedom of choice that exists in every other country. Governments across Canada had better hope he wins, or they will see their citizens trapped in a downward spiral of ever longer waiting lists and ravaged social programs.
Gwyn Morgan is a retired Canadian business leader who has been a director of five global corporations.