Is Canada Odd? A Comparison of European and Canadian Approaches to Choice and Regulation of the Public/Private Divide in Health Care

Abstract:     
Choice is often touted as a means for change within health care systems. Yet 'choice', in this context, takes at least three distinct forms: choice between providers within a publicly funded health care system; choice between competing insurers within a universal plan; and, lastly, choice as between privately financed health care and universal public coverage. In Canada, it is this last form of choice that is under active debate, particularly in light of the Supreme Court of Canada's decision in Chaoulli which found a regulation banning private health insurance for medically necessary care to be unconstitutional. The argument is frequently made that Canada is an outlier in having regulation that effectively precludes this kind of choice. This paper tests that argument by exploring regulation of choice of privately financed health care in several European countries - the Netherlands, Germany, Sweden, England and France. We highlight commonalities as well as differences, showing the extent to which these countries employ regulation to fetter growth of a large privately-financed sector. The paper's thesis is that Canada, in employing more intrusive forms of regulation, is not an outlier per se but at one end of a regulatory spectrum.

Number of Pages in PDF File: 26

Accepted Paper Series