Introduction: Seeking the Grail: Financing for Quality, Accessibility, and Sustainability in the Health Care System
EXPLORING SOCIAL INSURANCE: CAN A DOSE OF EUROPE CURE CANADIAN HEALTH CARE FINANCE?, McGill-Queen's University Press, 2008
36 Pages Posted: 27 Jun 2008
Date Written: March 25, 2008
Sustainability, quality, accessibility are front and centre questions in Canadian health care. Is it possible to obtain a balance of all three - a holy grail? Key contextual factors help frame this question. Increasingly, the locus of care is shifting out of the realm of medically necessary hospital and physician services for which universal first-dollar coverage is provided under the current Canadian model. In addition, expensive drugs are being developed, often of questionable benefit or alternatively offering significant benefits to a relatively small number of individuals, and pressure is put upon provincial governments to publicly fund these drugs, thus raising sustainability issues. Yet if the same drugs are not publicly funded, questions are raised about quality and accessibility of the public system. Cultural change, coupled with technological innovation is also a source of pressure. This is evidenced by individuals' unwillingness to wait for care or suffer limitations on access.
This paper explores the policy and financing options that are likely to move Canada towards an optimal balance of quality, accessibility, and sustainability. Of the three policy options - spending smarter, creating informed demand, and sustainable funding arrangements, it focuses on the last of these which has been relatively under-studied in the Canadian context.
Four models of mixed public and private finance for health care are examined: parallel or duplicate, group-based, co-payment, and sectorally based systems. The debate in Canada has largely been reduced to one of whether or not to allow a duplicate or parallel private health insurance tier and has ignored the wider funding questions to be researched and debated. This paper argues that allowing a parallel or duplicate private tier for physician and hospital services is not likely to help Canadian governments achieve a better balance of sustainability, quality and accessibility. As health care grows as a share of the economy across advanced nations, the ability of a single mode of public finance to keep pace is diminishing and other sources of public finance (apart from taxation revenues) such as social insurance deserve close consideration. Although in our view solutions for Canada probably do not lie in duplicate or private insurance, it is certainly worth exploring with great rigour the benefits and costs from a Canadian perspective of social health insurance and whether and to what extent adopting this mode of financing (in part) could assist Canada with finding the right balance of sustainability, accessibility and quality.
Keywords: Social Health Insurance, Health Law, Health Care, Health Policy, Public/Private Interface in Health Care, Canada Health Act
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