PUBLIC

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PUBLIC PRIVATE HEALTH CARE IN CANADA
by Norma Kozhaya, Ph.D. Economist, Montreal
Economic Institute

• before the
• Canadian Pension Benefits Institute
• Winnipeg - June 15, 2007

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Possible private contribution

• Possible private contribution in the health care
  sector
• Out-of-pocket financing
• Private insurance
• Private provision of publicly funded services
• PPP
• I will focus more specifically on the role of
  private insurance

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Context

• Canada is the only OECD country that prohibits
  the possibility of private insurance for
  medically required services (through provincial
  legislation).
• Canada is also one of the  biggest spenders  on
  health care
• What are the results? Value for our money?

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Financial sustainability

• Health care spending accounts for more than 10
  of our GDP (70 public, 30 private)
• With inflation taken into account, per capita
  public health care spending doubled in 30 years
  (CIHI).

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Financial sustainability

• More than 33 of total provincial government
  revenues are spent on health care
• In Quebec
• 44 of provincial program spending goes toward
  health care in 2006 compared to 35 in 1990.

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Financial sustainability

• Factors driving growth
• Population aging (the share of the elderly in the
  population 14 today, 23 in 2026)
• Technology
• New drugs
• Growth Projections for Canada Increase of 4 of
  GDP by 2040, (CD Howe), 4,2 in 2050, (OECD)

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Cost
Health care spending in OECD countries with
universal access as /GDP (2003, 8th)
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Cost and results

• Different measures of health care system
  performance two are of particular relevance for
  Canada
• Access
• Waiting time

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Cost and results
Number of doctors per 1000 inhabitants (24th)
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Cost and results
Public spending per capita and waiting times in
Canada 1993-2005
Source Fraser Institute Canadian Institute for
Health Information
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Private health insurance

• Private health insurance plays varying roles in
  OECD countries and fulfills different functions
  within health care systems.
• Five categories of insurance, from the most
  comprehensive to those complement to the public
  system.

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Private health insurance

• Among the five categories of insurance, only one,
  supplementary insurance, is already established
  in Canada for uninsured services.
• Three of the other four are unlikely to be
  offered, even following the Chaoulli ruling,
  because of the legal obstacles that remain.

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Private insurance new opportunities

• Duplicate insurance
• Individuals remain insured with the public system
  while paying for the option of being treated in a
  parallel private system, with no commitment of
  public funds to cover this care
• Exists notably in Finland, Italy, U.-K.,
  Australia, Ireland

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Private insurance new opportunities

• For greater overall financing.
• For more capacity to treat patients (more beds,
  more equipment, more operating rooms, etc.)
• To create more work in the private sector for
  existing medical staff, underused in the public
  system because of salary caps and quotas.

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Private insurance new opportunities

• To repatriate thousands of doctors and nurses
  working abroad.
• Without private insurance, only the wealthiest
  Canadians could obtain private treatment, often
  outside Canada, paying directly from their pockets

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Other possible private contribution

• User fees (exist in 78 of OECD countries).
• (Need to change the Canada Health Act
  eventually)
• Private provision of publicly funded services
  (Sweden, France, U.-K.)

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Public opinion
Question Would you find it acceptable or not if
the government were to allow those who wish to
pay for healthcare in the private sector to have
speedier access to this type of care while still
maintaining the current free and universal
healthcare system?
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Conclusion

• Its not part of Canadian values to let people
  suffer on waiting lists.
• The private sector does not threaten the public
  sector as OECD countries experience shows.