June 23, 2008
Separating the Twins
Canada and Alberta are behind on health reform; we should not be
If a grocery store ranked sixth highest for the cost of food, but among its competitors it ranked 23rd out of 30 for consumer satisfaction, few would say the store is a venue of choice. Twenty-third place is where Canada falls on the health-care satisfaction scale when it is compared to most European countries.
In this comparison of European and Canadian health care according to consumer sensitivity, Canada ranks below many European nations. The 2008 Euro-Canada report by the European Health Consumer Powerhouse and the Frontier Centre compares European countries with Canada based on 27 indicators including patient’s rights and information, waiting times, outcomes, generosity of pubic health-care systems and access to pharmaceuticals. On such measurements and others, Canada scored 550 out of 1,000 possible points. (Frontier Centre, 2008)
A 2007 study by the Fraser Institute had similar results. At least seven Organisation for Economic Co-operation and Development (OECD) countries – Austria, Belgium, France, Germany, Japan, Luxembourg and Switzerland – had shorter wait times than Canada and superior health-care outcomes in almost every category. (Esmail and Walker, 2007)
A suggestion for Alberta: Separate the provider from the purchaser
The World Health Organization reports that an increasing number of countries contract out health-service delivery. It is an alternative to traditional publicly delivered health care.
There are alternatives to the Canadian model where a provincial government owns much of the health infrastructure, collects much of the money to pay for health care and contracts with itself to deliver the health care. In this closed loop, there is little room for competition in service delivery, which is as necessary to health care as it is to the provision of food.
The purchaser-provider split is one of the main findings in the Euro-Canada comparison. The top six providers – Austria, the Netherlands, France, Switzerland, Germany and Sweden –have purchaser-provider splits, as do other countries trying to move up in the rankings. My report details two models, Sweden and the Catalonia region in Spain.
Mark Milke, Director of Research
also lectures in Political Science at the University of Calgary where he received his doctorate. He is the author of three books on Canadian politics, including the 2006 A Nation of Serfs? How Canada’s Political Culture Corrupts Canadian Values from John Wiley & Sons. He is a former director (first in Alberta and then British Columbia) with the Canadian Taxpayers Federation 1997-2002. Since 2002, among other work, Mark has written policy papers on British Columbia’s treaty process, the Canada Pension Plan, Alberta’s Heritage Fund, automobile insurance, corporate welfare and the flat tax. He is writing a book on the effects of anti-Americanism on deliberative democracy in Canada and is a Sunday columnist for the Calgary Herald. In addition, his columns on politics, hiking, nature and architecture have been published across Canada including in the National Post, Globe and Mail, Reader’s Digest, The Western Standard, Vancouver Sun, and Victoria Times Colonist and the Washington DC magazine on politics, The Weekly Standard.