This week, as the Trudeau government chastised provinces that allow patients to use their own money to purchase health care from private providers, a new survey by the Angus Reid Institute finds that 43% of Canadians believe patients should be able to do exactly that.
In fact, in every province except Ontario, a plurality of Canadians support the ability of patients to personally pay a private clinic out-of-pocket for faster access to some surgeries and diagnostic tests. Clearly, Canadians view of how our health-care system should function differs from the Trudeau government’s outdated opinion.
More generally, the survey found that a significant portion of Canadians now either support—or, at the very least, are cautiously interested in—more private-sector involvement in health care. Almost one-third of Canadians are outright “Private Care Proponents” while a further one-third are “Curious but hesitant” about the extent of reforms.
Together, these groups represent 61% of survey respondents compared to 39% who staunchly defend the purely public status quo, which is clearly failing patients and taxpayers.
That the majority of Canadians now see some role for the private sector suggests a clear acknowledgement of the fundamental problems with our current approach, which is unsurprising given that Angus Reid also reports that 69% of respondents rate the current state of health care as “poor” or “very poor, in crisis.”
This perception is understandable. The media is awash with stories of burned out health-care staff, overcrowded hospitals and long wait times. But these stories are also backed by data.
For example, in 2022 Canadians could expect a median wait of 27.4 weeks between referral to a specialist by a general practitioner and receipt of treatment. While some try to blame these waits on the pandemic and associated surgical postponements, Canadians were already waiting 20.9 weeks in 2019, long before COVID. Clearly, our health-care system suffers from structural problems that predate the pandemic.
Fortunately, we can find solutions in other universal systems that have shorter wait times for specialist consultations and elective treatments—and, it turns out, many Canadian support these policy reforms.
According to the Angus Reid survey, a plurality of Canadians (46%) support Australia’s use of private insurance for non-covered services and faster access in private hospitals, while a majority (60%) support “dual practice” for doctors in the public and private system. And 52% of Canadians support the United Kingdom’s private parallel system where patients can pay for non-covered services or procedures with long waits in the public system.
Finally, a whopping 78% support allowing more surgeries and tests performed in private clinics while 40% only support this policy to clear the surgical backlog.
But Canadians need not look overseas for evidence on how publicly-funded surgeries in private clinics can reduce wait times. British Columbia used private clinics to reduce its surgical backlog while Alberta and Ontario are now embracing these partnerships, perhaps for the long term.
And, perhaps most tellingly, the Saskatchewan Surgical Initiative, which included private-public partnerships, helped reduce that province’s wait between referral from a GP and receipt of care from 26.5 weeks in 2010 (the longest wait outside Atlantic Canada) to the second-shortest in the country at 14.2 weeks in 2014. During this initiative, the cost for surgeries in the private clinics was 26% lower (on average) than in the public sector.
Of course, concerns remain. More than two-thirds of Canadians believe that lower-income Canadians will suffer if health-care privatization increases, and that it would worsen staffing shortages.
This is why design matters. While more successful universal health-care systems around the world embrace the private sector as a partner, they also expect patients to share the cost of treatment while providing generous safety nets for vulnerable populations.
While it’s encouraging to see more Canadians support common sense health-care reform based on the experiences of other universal health-care systems, it’s unfortunate that the debate is still being framed in terms of the supposed “privatization” of the “public” system.
Other universal health-care systems have long figured out that it’s not a question of public or private, but rather public and private coming together to best serve the needs of patients.
Bacchus Barua and Mackenzie Moir are analysts at the Fraser Institute.