Increased Private Healthcare for Canada: Is That the Right Solution?

Medicare is a publicly funded healthcare system that is a source of national pride in Canada; however, Canadians are increasingly concerned about its performance and sustainability. One proposed solution is private financing (including both private for-profit insurance and private out-of-pocket financing) that would fundamentally change medicare. We investigate international experiences to determine if associations exist between the degree of private spending and two of the core values of medicare – universality and accessibility – as well as the values of equity and quality. We further investigate the impact of private spending on overall health system performance, health outcomes and health expenditure growth rates. Private financing (both private for-profit insurance and private out-of-pocket financing) was found to negatively affect universality, equity, accessibility and quality of care. Increased private financing was not associated with improved health outcomes, nor did it reduce health expenditure growth. Therefore, increased private financing is not the panacea proposed for improving quality or sustainability. The debate over the future of medicare should not be rooted in the source of its funding but rather in the values Canadians deem essential for their healthcare system.

[1]  C. Flood,et al.  A successful Charter challenge to medicare? Policy options for Canadian provincial governments , 2018, Health Economics, Policy and Law.

[2]  Amélie Quesnel-Vallée,et al.  Canada's universal health-care system: achieving its potential , 2018, The Lancet.

[3]  Ronald Kneebone,et al.  Effect of provincial spending on social services and health care on health outcomes in Canada: an observational longitudinal study , 2018, Canadian Medical Association Journal.

[4]  Eyal Oren,et al.  Measuring progress and projecting attainment on the basis of past trends of the health-related Sustainable Development Goals in 188 countries: an analysis from the Global Burden of Disease Study 2016 , 2017, Lancet.

[5]  Eyal Oren,et al.  Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990–2015: a novel analysis from the Global Burden of Disease Study 2015 , 2017, The Lancet.

[6]  Abdulwahab A Alkhamis.  Critical analysis and review of the literature on healthcare privatization and its association with access to medical care in Saudi Arabia. , 2017, Journal of infection and public health.

[7]  G. Marchildon,et al.  Bending the Cost Curve in Health Care , 2014 .

[8]  M. Mckee,et al.  Quality Check: Does it Matter for Quality How You Organize and Pay for Health Care? A Review of the International Evidence , 2014, International journal of health services : planning, administration, evaluation.

[9]  K. Garthwaite,et al.  All Things Being Equal: Does it Matter for Equity How You Organize and Pay for Health Care? A Review of the International Evidence , 2014, International journal of health services : planning, administration, evaluation.

[10]  M. Smadu.  Chronic Condition: Why Canada’s Health-Care System Needs to Be Dragged into the 21st Century , 2013 .

[11]  R. Dion,et al.  Chronic Healthcare Spending Disease: A Macro Diagnosis and Prognosis , 2011 .

[12]  Cathy Schoen,et al.  How health insurance design affects access to care and costs, by income, in eleven countries. , 2010, Health affairs.

[13]  Who still has the worst health system of them all? , 2010, The Lancet.

[14]  J. Newhouse,et al.  Income, insurance, and technology: why does health spending outpace economic growth? , 2009, Health affairs.

[15]  B. Hanning.  Private care and public waiting. , 2005, Australian health review : a publication of the Australian Hospital Association.

[16]  Wendy Armstrong,et al.  Building on Values: The Future of Health Care in Canada , 2005 .

[17]  C. Flood,et al.  Strengthening the Foundations: Modernizing the Canada Health Act , 2002 .

[18]  Jennifer Long,et al.  A New Method for Database Data Quality Evaluation at the Canadian Institute for Health Information (CIHI) , 2002, ICIQ.

[19]  G. Stoddart,et al.  User Fees for Health Care: Why a Bad Idea Keeps Coming Back (Or, What's Health Got to Do With It?) , 1995, Canadian Journal on Aging / La Revue canadienne du vieillissement.