As progress on modernizing Canadian healthcare delivery remains very slow, and with medical advances and an increasingly aging population, health policymakers should look to the Dutch model, which provides a good example of how managed competition can promote efficiency while preserving the principles of universal insurance and an equitable sharing of the cost, according to a new report from the C.D. Howe Institute. "It's time to break through the logjam and open debate to serious exploration of new options. Specifically, we should look more carefully at pluralistic, multi-payer models that allow for some choice and competition," says the author of the report, health care economist Åke Blomqvist.
The US multi-payer system clearly is not a good example, but there are several other nations who employ a model with more insurance choice and whose healthcare performance is often ranked as equivalent to, or even better than, Canada's. In Going Dutch: Choice, Competition and Equity in Healthcare, Blomqvist points to the Dutch model to demonstrate that competition can create efficiency while not abandoning universality and equity.
"We should draw on the example of these pluralistic systems and try to set up a model in which some degree of regulated public-private competition helps move us away from the expensive and unwieldy healthcare system in which we appear to be currently stuck," explains Blomqvist.
In the Netherlands, universality is ensured by means of compulsory insurance, and equity is attained through requirements that plans have open enrollment and through a system of government-funded risk-adjusted vouchers that people can use as partial payment of the premiums charged by the plans they choose. Further, Canada's outdated model isn't equipped to keep up with pharmaceutical or technological progress in medicine or tackle the highly specialized and sophisticated health care requirements of today. As our populace ages and the demand for care grows, a pluralistic system with competing plans can better adapt, while the single-payer model remains less agile since all decisions about its functioning are heavily dependent on politics. Competition within a universal coverage system would improve adaptability and allow for care that effectively addresses individual and changing health demands.
"It would be good public policy to allow a pluralistic health financing system with a choice among several plans because competition would increase the likelihood that the healthcare system could adapt to changing needs and medical technology," says Blomqvist.
To ease the shock of transitioning to a multi-payer system, both politically and functionally, the author recommends that provinces keep the current, government-run plans as a default while allowing for competing public and private plans. To set the process in motion, provinces could introduce a choice for consumers between two alternative public-sector plans. Individuals would be allowed to opt out of the traditional plan and choose an alternative government plan with gate-keeping primary-care practitioners, as in the UK, in which patients would agree to get all their care from the practice that has them on its roster, or through a referral from that practice.
Åke Blomqvist is Adjunct Research Professor, Carleton University; Fellow-inResidence, C.D. Howe Institute.