Advantages to "Parallel" System a Myth
Mar 03, 2008
Those who advocate for the increased privatization of the medicare system in Canada now often resort to the promotion of what is referred to as “parallel health care.” This is the notion that we can have two separate and relatively independent health systems – one private and one public – coexisting and, most importantly, having a positive effect with regard to reducing wait times in the public system. But history has shown us that not only are such parallel systems no better in terms of wait times than purely public ones, they often make the public system less efficient and wait times even longer.
While it’s difficult for advocates of private health care systems to use the USA as an example for Canada to emulate because of the obvious flaws within it, they choose instead to make comparisons to European countries that have created parallel systems. Most of them allow private, for profit facilities to operate next to public ones, so that patients with the financial means can jump the queue and be treated in a private clinic. Advocates of this approach argue that this reduces waiting times because it removes people from the waiting lists. This should be a win-win situation then, whereby everyone gets speedier treatment as a result.
However, studies have shown that this is not the case. In England - where a fully parallel system exists – wait times were about three times than the longest ones in Canada. Other countries like Australia also have mixed systems, and their wait times have so far been longer than countries with public-only systems. Even more importantly, studies have shown that patients in a private system do not live longer or have a better quality of life than those in a public system, and may actually suffer higher rates of illness and death.
One of the things that advocates of private or parallel systems don’t tell you is that there are only a finite number of doctors. Obviously it is more lucrative for them to practice privately. This reduces the number working in the public system. And those working in both have an incentive to keep public waiting lines long, as this encourages patients to make the decision to pay for private care.
So the notion that everybody benefits from a parallel system is a myth. It allows some to get timely care, but compromises access for those who most need it and cannot afford private care. The dangers and risks of allowing the growth of a private system in Canada just do not justify the potential of increased access for a few affluent individuals at the expense of everyone else.
Equality is a fundamental Canadian value. And health care based on need and not the ability to pay is the most valued feature of our health care system. Fortunately, most wish to maintain the system we have, whatever its challenges. But we can’t fall for the promise that the adoption of private or parallel systems will make things better for everyone. This just isn’t the case.
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I believe that doctors in a public system want to help their patients. In Britain, doctors receive bonuses when they help reduce how often a patient goes to their doctor. Whereas doctors with a private practice want to help you, but they also think about the money they can make from the patient, or the patient’s insurance company – if they are covered. And insurance companies receive bonuses when they deny coverage. My family has benefited from a public system and for that I’m thankful for living in Canada. The public health system has improved our quality of life.
Al - -0001-11-30 00:00
#1, health care spending - in Canada, health care spending is 9.8% of GDP. In the UK, it's 8.3%. We spend billions more on health care than the English, so we should expect to see a difference. As the article points out, the Americans are a complete basket case and shouldn't be used as a comparison - they're 15.3% of GDP. Frightening. #2, finite number of doctors - Canada had 2.2 practicing physicians per 1000 population, well below the OECD average of 3.0, and the number of doctors has stayed stable over the last 15 years. The argument that there are only a finite number of doctors doesn't seem to hold much water (shouldn't Canada have MORE doctors if that was true?) It's not how many doctors you have, it's what you do with those doctors that matters. #3, the nurse element - Canada has 10.0 qualified nurses per 1000 population - WAY more than the OECD average of 8.6. That would make a difference. That number is decreasing over the past 15 years, though the decline has been halted recently. The question might be: do you need more nurses handling lower-level problems, directing traffic to a few highly-paid specialist doctors? (data from the OECD - http://www.oecd.org/dataoecd/46/33/38979719.pdf)
Dave (on behalf of Cory) - -0001-11-30 00:00