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

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

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?

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

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

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

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

Public spending per capita and waiting times in Canada Cost and results Public spending per capita and waiting times in Canada 1993-2005 Source: Fraser Instituts; Canadian institute for health information

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.

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.

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

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.

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

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.)

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?

Thank you