1. PUBLIC VS. PRIVATE HEALTH CARE IN CANADA
Norma Kozhaya, Ph.D
Economist, Montreal economic Institute
CPBI, Winnipeg
June 15, 2007

2. Possible private contribution
Possible private contribution in the health care sector:
Out-of-pocket financing
Private insurance
Private provision of publicly funded services
PPP
I will focus more specifically on the role of private insurance

3. Context
Canada is the only OECD country that prohibits the possibility of private insurance for medically required services (provincial legislation).
Canada is also one of the « biggest spenders » on health care
What are the results?

4. Financial sustainability
With inflation taken into account, per capita public health care spending doubled in 30 years (CIHI).
More than 30% of total provincial government revenues are spent on health care

5. Financial sustainability
In Quebec, more than 43% of provincial program spending goes toward health care in 2006, compared to 35% fifteen years ago.
Growth Projections : (increase of 4% of GDP in 2050)
Factors driving growth:
Population aging
Technology
New drugs

6. Cost
Health care spending in OECD countries with universal access in 2003 (% GDP)

7. Number of doctors per 1000 inhabitants (24th)
Cost and results
Number of doctors per 1000 inhabitants (24th)

8. Public spending per capita and waiting times in Canada
Cost and results
Public spending per capita and waiting times in Canada
Source: Fraser Instituts; Canadian institute for health information

9. Private Health Insurance
Private health insurance plays varying roles in OECD countries and fulfills different functions within health care systems.
Five categories of insurance, from the most comprehensive to those complement to the public system.

10. Private Health Insurance
Among the five categories of insurance, only one, supplementary insurance, is already established in Canada for doctors and hospital care.
Three of the other four are unlikely to be offered, even following the Chaoulli ruling, because of the legal obstacles that remain.

11. Private insurance : new opportunities
Duplicate insurance
Individuals remain insured with the public system while paying for the option of being treated in a parallel private system, with no commitment of public funds to cover this care
Exists notably in Finland, Italy, U.-K., Australia, Ireland

12. Private insurance : new opportunities
For greater overall financing.
For more capacity to treat patients (more beds, more equipment, more operating rooms, etc.)
To create more work in the private sector for existing medical staff, largely underused in the public system because of salary caps and quotas.

13. To repatriate thousands of doctors and nurses working abroad.
Without private insurance, only the wealthiest Canadians could obtain private treatment, often outside Canada, paying directly from their pockets

14. Other possible private contribution
User fees (exist in 78% of OECD countries).
Need to Change eventually the Canada Health Act
Private provision of publicly funded services (Sweden, France, U.-K.)

15. Question: Would you find it acceptable or not if the Government were to allow those who wish to pay for healthcare in the private sector to have speedier access to this type of care while still maintaining the current free and universal healthcare system?

16. Thank you