Competition, consumer choice keys to improving Canadian health care

The only thing Canadians seem to discuss more than hockey or the weather is the state of the country's health care system.

Canadians cherish their universal, single-payer system even while they complain about waiting lists and politicians wring their hands over soaring costs.

Now researchers at the University of Western Ontario have concluded Canadians should be taking a more active role in the system - a "consumer-driven" approach based on competition among health care providers.

The National Post reports that a research paper found Canada could learn some lessons from health care systems in Europe and Australia.

Researchers analyzed health care in seven industrialized countries and found elements they say could help provincial governments curb spiraling costs and deal with chronic service shortcomings.

What some of those countries have in common is they allow citizens to pick and choose services they receive funded by private health insurance.

"We're always comparing ourselves to the U.S.," Anne Snowdon, head of the university's Ivey International Centre for Health Innovation, told the Post. "But when you look across OECD countries, really the U.S. is not the benchmark you want to compare your system to.

"It's really the other national health systems, which have similar structures to Canada, but perhaps much better outcomes."

Key recommendations include using insurance or personal health budgets to create financial incentives that empower consumer decision-making to promote competition and innovation, tracking the impact of innovation on the system's sustainability and patient outcomes, and moving the Canadian system away from its focus on acute care to a community-based system focused on prevention and managing chronic illness.

The Western report isn't the first study to suggested some services be handled through private delivery but many critics worry it will lead to two-tier health care.

The Western study looked at the U.S. system but focused more on Britain, Germany, the Netherlands, France, Switzerland and Australia, which have universal structures similar to Canada's but use their funding more efficiently.

The report's most radical recommendation: adapt practices from countries that ensure universal access but allow people to buy health insurance to cover all or some of their care. Patients in countries such as Germany and Switzerland pay no more, regardless of how much they access the system, but can tailor services to best meet their needs, according to the study.

The report concedes there's little empirical evidence on what works best but the data suggest such a system allows patients and doctors to better manage their care, which puts less strain on emergency rooms and acute-care hospitals, which tend to be more expensive cost-wise.

The key lesson, said Snowdon, was that Canada's health care culture should shift from a top-down approach, where patients are told what treatment they can and can't have, to one that lets them manage their own care.

"What I felt was quite striking across a number of these other countries is the role of consumer choice," she said. "As soon as consumers start to select and choose … then you introduce into those systems some element of competition. Then the providers for those services suddenly need to respond to consumer demand, or lack thereof."