Introduction and Summary

Canada's Medicare system is under increasing strain. It faces recurring crises in its present form, despite a continuous, decades-long allocation of more tax resources. At the same time, Canadians clearly want guaranteed, universal access to medical services. New healthcare models have the potential to retain universality, restore service levels, and control costs while introducing transparency and accountability to the system.

The Need

The decision to structure Medicare as a monopoly has had effects that are both far-reaching and little understood. Although consumers do retain a limited ability to choose between doctors and hospitals, the terms, prices and conditions at these facilities are for the most part identical. Because their funding arrives whether or not they provide good service, health-care workers have no direct incentive to satisfy their clients or to innovate to provide better service.

A high-performance medical system is a necessary condition of social and economic health and FCPP has examined other models that reconnect spending with the needs of patients and providers. One consists of competitive delivery systems like the one found in Stockholm, Sweden, where direct public funding flows through a framework of bidding for service by public and private providers. Another example is Singapore's system of Medical Savings Accounts, which has simultaneously reduced costs and induced world-class quality by expanding the power of health-care consumers.

The Future

Policy makers in Canada have a tremendous opportunity to renew this region's vitality by redefining our medical system. To feed an increasing appetite for social and health-care services from an aging population, the pressure to raise taxes to pay for them moves up constantly. Meeting these demands requires that we sweep aside comfortable assumptions and old thinking, particularly the simplistic answers of adding ever more resources into a system with little incentives to innovate and modernize. The Frontier Centre has an important role in encouraging people to understand and deal with the social and economic forces that are shaping our future. After years of governments funneling more money into a dysfunctional system, the Healthcare Frontiers Project (HFP) will illustrate how we can do better by looking at it in new ways. It will strive to accomplish the following:

• Examine ways to broaden the frame of reference to ensure that health-care policies deal with the entire economy as opposed to one sector alone;
• Assess public sector institutional constraints to the development and delivery of health-care policies and programs;
• Evaluate the impacts of regulatory policies, regimes, and legislation on the development of a patient or consumer centred health-care policy;
• Emphasize structural reform (changing how it is done) over resource reforms (increasing budgets for the status quo); and
• Look at ways of creating an institutional environment in which the healthcare industry can become a major driver of economic activity, including its potential as a major export sector for value-added services and a source of medical innovation and high-value jobs.

While present health-care policies can not effectively meet the needs of an aging population, the Centre firmly believes that opportunities abound for provinces that choose to become national leaders in this field. Our mandate is to bring these possibilities to the public forefront, and place them on the public agenda.

A European Focus - Frontier Partnership with Leading European Health Policy Think Tank

The Frontier Centre partners with the Brussels-based Health Consumer Powerhouse, one of Europe's leading health policy think tanks.  Every year the Centre works with the HCP to 1) measure the consumer friendliness of Canada's healthcare system in relation to European nations; and 2) compare the state of consumer based healthcare between our provinces.   In the future, this partnership will be expanded to include more countries and other disease specific indexes. 

 

 

Much of the debate over healthcare in Canada is framed in terms of moving towards or away from a United States model of healthcare.  Given the undesirability of a U.S. style model, the conclusion is usually that there is no alternative to the status quo.  However the Frontier Centre has made a point of comparing the Canadian system to European models which are more subtly different to Canada’s.  The 2009 Euro-Canada Healthcare Consumer Index placed Canada 23^rd out of 32 countries for

quality of healthcare from a consumer perspective and last once spending levels were accounted for.  Canada can learn from countries such as France and Sweden by:

 

·         Being neutral about whether public or private providers are used to supply healthcare even when government remains the payer.

·         Retaining universal coverage but no longer having government as the single provider.

·         Investigating the possibility of medical savings accounts to remove the third party payer problem to some extent.

·         Shifting the incentives of hospitals towards producing outputs by moving to fee for service budgets rather than global budgeting.

 

Recommended Audio -

 

Health Consumer Powerhouse President Johan Hjertqvist on consumer-focused healthcare in Europe - radio interview