Market solutions should be used to improve health care
The issue of health care has often come to the fore during elections, and the current Quebec election is no exception. Indeed, with the election campaign far from over, the main parties vying for power have already unveiled their main health-care proposals.
Even if some of these proposals are eventually put in place, we will still have a long way to go before having a quality health-care system comparable to those in many industrialized countries.
In Quebec, the provision of care deemed “essential” remains largely monopolized by the public sector to this day. As for the role of private health insurance, it is limited solely to coverage of services not insured by the public regime. Apart from radiologists, medical specialists are not authorized to treat patients in the private sector while maintaining their practices in the public system.
No industrialized OECD country imposes as many restrictions on its citizens in the field of health care.
Do these constraints give rise to better results, in terms of access to, and quality of, services offered? Judging by the foreign experience, the answer is a resounding “no.”
Compared with the vast majority of OECD countries, the results of Quebec’s public health-care system are very disappointing, and the situation is not improving. In international rankings, Quebec at best finds itself in the middle of the pack when comparing quality-of-care indicators, while its health-care expenditures are among the highest.
With regard to wait times for required care, the province of Quebec, like the rest of Canada, has been near the bottom of the list for many years. Overcrowded emergency rooms are just as worrisome a problem as they were 30 years ago, despite the increasing resources devoted to the system over the years.
Poll after poll has shown that a majority of Quebecers are dissatisfied with the system and want the government to explore private-sector options. In this regard, there are numerous models to follow.
The latest OECD data, for example, show that over a third of hospitals in Germany, Australia, Spain, France and Italy, all countries whose health-care systems are based on the principle of universality, are private for-profit institutions.
In at least a dozen countries, including Denmark, Norway and Sweden, a growing number of citizens are taking advantage of the option of purchasing private health insurance to cover expenses for elective surgery obtained in private hospitals and clinics.
Despite the fear of a certain portion of the Quebec population that greater reliance on the private sector would lead to a two-tier system, these international examples show that notions of freedom of choice, competition and profit are not incompatible with health care that is accessible to all.
On the contrary, the reforms undertaken in other OECD countries have provided substantial benefits, especially in terms of improving wait times and service quality.
Whichever party wins the upcoming election, the government of Quebec no longer has any excuse not to reform the health-care system and incorporate market solutions, just like other industrialized countries have successfully done. It is in this way that we will succeed in solving our health-care system’s most pressing problem — namely, our interminable waiting lists.
Six proposed health-care reforms from the Montreal Economic Institute:
- Promote freedom of choice for patients and competition between health-care providers
- Promote the emergence of a true private hospital market
- Increase funding for health care through duplicate private health-care insurance
- Allow mixed public-private practice to increase the supply of medical specialists
- Fund hospitals based on services rendered
- Make the publication of hospital performance indicators mandatory
Yanick Labrie est chercheur associé à l'Institut économique de Montréal. Il signe ce texte à titre personnel.