ESMAIL, MOIR: Smith gov’t health-care vouchers step towards successful Euro model

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Only in Canada could the Smith government’s new plan — which would give patients waiting too long for health care vouchers to access care elsewhere in the province including in private facilities — be called a path to “American-style” health care.

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While opponents of reform seem to call every new policy proposal the “Americanization” of health care, in reality the government appears to be learning from European countries whose universal health-care systems regularly outperform our own.

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Patients in EU have alternatives

Indeed, in the European Union, patients may choose a public or private health-care facility in another EU country, with their home country paying up to what the service would have cost if it took place at home. While the approach to this policy varies by country, the message is clear — patients waiting have an alternative.

In a similar vein, last year universal health insurance providers in the Netherlands agreed to redirect patients to more timely care in that country’s private clinics and hospitals if the patient’s wait times exceeded Dutch targets. In other words, Dutch policymakers recognize it’s a bad idea to allow patients to wait too long, both in terms of health outcomes and the potential increased cost of caring for deteriorated and more complex cases.

And the Dutch targets are remarkably short by Canadian standards — just four weeks for specialist diagnosis and assessment, plus six weeks (outpatient treatment) or seven weeks (for inpatient treatment). Meanwhile, the pan-Canadian benchmarks for wait times that Canada’s provinces “strive to meet” are up to 26 weeks for joint replacement and open heart surgery, after waiting many weeks to see a specialist in the first place.

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Back in Alberta, if there’s any real criticism of the Smith voucher plan, it would be that it still falls short of how health care works more successfully in countries such as the Netherlands, Germany, Switzerland and Australia where wait times are much shorter, health-care services more abundant, and spending similar or lower than in Canada.

The Smith government should focus not only on how other universal health-care countries provide patients an option to avoid their (much shorter) wait times, but also on how other countries got those much shorter wait times in the first place.

In every top performing universal health-care country in the developed world, private competition and private payment (including private hospitals and patient cost-sharing) play a much larger role than in Alberta — even after accounting for the Smith government’s planned reforms (i.e. the government paying hospitals for actual services they provide rather than lump-sum budgets, and allowing private purchases of health care from doctors in both public and private settings).

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Gov’t should press on with reforms

To truly emulate these more successful universal health-care systems, the Smith government must ignore the naysayers and continue on the path to reform, for the benefit of patients who want shorter wait times (and more accessible services) and taxpayers who already pay more than enough for health care.

Despite ill-informed claims to the contrary, the Smith government’s latest reform proposal is not a move away from universality. Rather, it’s another step towards the successful European model for health care. And in fact, the reforms as proposed don’t go far enough.

Nadeem Esmail and Mackenzie Moir are analysts at the Fraser Institute.

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