We have lots to learn on health care; Spending: Systems in other countries lead way in ... - 0 views
www.fpinfomart.ca/doc/doc_display.php?key=pr|242663|vasn|20150228|215425955
from heather international comparisons medicare privatization
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Vancouver Sun Sat Feb 28 2015
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Americans spend a king's ransom on health care - 17.9 per cent of GDP, versus 10.9 per cent here - yet the U.S. finishes last in a Commonwealth Fund ranking based on 11 developed countries' health care quality, access, efficiency and equity. Before you start feeling too smug about this, consider that Canada ranked second-last. And before you reject everything in the Americans' health care tool chest, consider that some approaches they embrace and we shun - letting private insurance plans run in parallel to public plans, for example, or allowing private payments for services exclusively covered by government insurance in Canada - have been adapted and adopted by the higher-ranked countries in limited and careful, but highly effective, ways.
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And here's the kicker - all of these countries' public systems cover a broader range of services than Canada, with its narrow focus on doctors' fees and hospital costs. Blomqvist and Busby note that Canadian governments cover about 70 per cent of our health care expenditures, roughly the average of all 34 OECD countries. But, thanks to pervasive restrictions that prevent or sorely limit private funding of ever-rising hospital and doctorrelated costs, little or no public money is available to fund things like universal outpatient drugs, eye care and dental plans that other countries routinely provide for citizens.
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As analysts Ake Blomqvist and Colin Busby note in a new C.D. Howe Institute study, "Many other countries, in Europe and elsewhere, also have systems that cost much less than the American one and that, arguably, are at least as equitable as Canada's, if not more so." Yet, "No other country is modelling their health-financing system around the Canadian example," they add. "None of them seem to think that a monopoly approach to paying for most health services is the best way to achieve equity and efficiency goals."
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Many of these restrictions do not flow from the Canada Health Act, but rather from provincial laws. For example, Victoria, not Ottawa, prohibits doctors who opt out of the Medicare system from getting any payments from public funds, or doctors who work within the public system from billing patients over and above what the government pays. These restrictions, the study argues, impose big costs. To illustrate this, it focuses on how health care is paid for in four countries - the U.K., Australia, Switzerland and the Netherlands - whose health systems are considered to be among the world's best.
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"Their guiding principles are similar to those within the Canadian health care system. All endorse universal public coverage and access for a defined core set of services, the belief that costs should be borne by society at large ... and high standards of care." In all these countries, public spending covers a significantly smaller percentage of hospital and doctor-related costs than in Canada, leaving the balance to be paid by private insurance for those who have it. (The range is from 65-85 per cent for hospital costs, compared to 92 per cent in Canada, and 60-90 per cent for doctors fees, compared with 99 per cent in Canada.)
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But their governments also cover 45-67 per cent of drug and other outpatient medical costs, compared with 35 per cent in Canada. The authors consider, and ultimately dismiss, the view that any deviation from Canada's single-payer system would result in higher costs - an often-cited factor when sky-high U.S. health costs are dissected, but not an issue in countries that have a more carefully balanced mix of public and private funders.
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Nor do they buy the argument that the public sector would lose out if privately paid health services were allowed to compete for doctors and patients. Indeed, other countries have found that competition can improve service and lower costs. The bottom line is that Canada's health care system only looks as good as many of us like to think it is when we compare it to the American system. And other countries have figured out better ways to fully respect the same vaunted principles Canada aspires to while providing more or better care at comparable cost. We could learn from them.