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Is Canada odd? A comparison of European and Canadian approaches to choice and regulation of the public/private divide in health care

Published online by Cambridge University Press:  01 July 2010

Colleen M. Flood*
Affiliation:
Canada Research Chair in Health Law & Policy, Faculty of Law, University of Toronto and Scientific Director, CIHR Institute of Health Services and Policy Research, Canada
Amanda Haugan
Affiliation:
JD student, Faculty of Law, University of Toronto, Ontario, Canada
*
*Correspondence to: Colleen M. Flood, CIHR – Institute of Health Services & Policy Research, Faculty of Law, University of Toronto, 39 Queen’s Park Crescent East, Toronto, Ontario M5S 2C3, Canada. Email: colleen.flood@utoronto.ca

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 was unconstitutional. The argument is frequently made that Canada is an outlier from other countries in having regulation that effectively precludes this kind of choice. This issue is likely to become of concern again in upcoming constitutional challenges where applicants are looking to overturn through judicial challenges Canada’s medicare system. This article tests that argument of whether Canada truly is ‘odd’ from a comparative policy perspective 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 article’s thesis is that Canada, in employing more intrusive forms of regulation, is not an outlier per se but at one point in a regulatory spectrum.

Type
Articles
Copyright
Copyright © Cambridge University Press 2010

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References

Anell, A. (2008), The Swedish Health Care System, New York: The Commonwealth Fund.Google Scholar
Bevan, G.Hood, C. (2006), ‘What’s measured is what matters: targets and gaming in the English public health care system’, Public Administration, 84: 517538.Google Scholar
British Medical Association (2003), The New 2003 national consultant contract for England – a summary by the BMA’s Central Consultants & Specialists Committee, London, England: British Medical Association, http://www.bma.org.uk/ap.nsf/Content/CCSCContractSummaryGoogle Scholar
Busse, R. (2008), The German Health Care System, New York: The Commonwealth Fund, http://www.commonwealthfund.org/usr_doc/Germany_Country_Profile_2008_2.pdf?section=4061Google Scholar
Couffinhal, A.Paris, V. (2003), Cost Sharing in France, CREDES, http://www.irdes.fr/english/wp/CostSharing.pdfGoogle Scholar
Department of Health (2003), A Code of Conduct for Private Practice: Guidance for NHS Medical Staff, UK: Department of Health, http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4100689Google Scholar
Department of Health (2004a), The NHS Improvement Plan: Putting People at the Heart of Public sSrvices, UK: Department of Health, http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4084476Google Scholar
Department of Health (2004b), A Code of Conduct for Private Practice – Recommended Standards of Practice for NHS Consultants, UK: Department of Health, http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_085197Google Scholar
Department of Health and Aging (2008), Working in Private Practice, Australia: Department of Health and Aging, http://www.doctorconnect.gov.au/internet/otd/publishing.nsf/Content/work-Working-in-private-practiceGoogle Scholar
Devereux, P. J., et al. (2002), ‘A systematic review and meta-analysis of studies comparing mortality rates of private for-profit and private not-for-profit hospitals’, The Canadian Medical Association Journal, 166(11): 13991406.Google Scholar
Dourgnon, P., et al. (2007), ‘Introducing gate keeping in France: first assessment of the preferred doctor scheme reform’, Issues in Health Economics, http://www.irdes.fr/EspaceAnglais/Publications/IrdesPublications/QES124.pdfGoogle Scholar
Durand-Zaleski, I. (2008), The French Health Care System, New York: The Commonwealth Fund, http://www.commonwealthfund.org/topics/topics_show.htm?doc_id=674975Google Scholar
Enthoven, A. C.van de Ven, W. (2007), ‘Going Dutch – managed-competition health insurance in the Netherlands’, The New England Journal of Medicine, 357(24): 24212423.CrossRefGoogle ScholarPubMed
Flood, C. M.Archibald, T. (2001), ‘The illegality of private health care in Canada’, Canadian Medical Association Journal, 164(6): 825830.Google ScholarPubMed
Flood, C. M., Roach, K.Sossin, L. (eds) (2005), Access to Care, Access to Justice, Toronto: University of Toronto Press.Google Scholar
Glenngård, A. H., et al. (2005), Health Care Systems in Transition: Sweden, Brussels: European Observatory on Health Systems and Policies, http://www.euro.who.int/document/e88669.pdfGoogle Scholar
Greß, S. (2007), ‘Private health insurance in Germany: consequences of a dual system’, Health Care Policy, 3(2): 2937.Google Scholar
Greß, S., Manouguian, M.Wasem, J. (2007), ‘Health Insurance Reforms in the Netherlands’, CESifo DICE Report, 5(1): 63.Google Scholar
Grignon, M., Perronnin, M.Lavis, J. N. (2008), ‘Does complementary health insurance help the poor to access health care? Evidence from France’, Health Economics, 17(2): 203219.CrossRefGoogle ScholarPubMed
Health Canada (2007), Canada Health Act: Annual Report 2006–2007, Ottawa, Canada: Health Canada, http://www.hc-sc.gc.ca/hcs-sss/pubs/cha-lcs/2006-cha-lcs-ar-ra/index-eng.phpGoogle Scholar
House of Commons Committee of Public Accounts (2007), Fifty-ninth Report, http://www.publications.parliament.uk/pa/cm200607/cmselect/cmpubacc/506/50602.htmGoogle Scholar
Klazinga, N. (2008), The Dutch Health Care System, New York: The Commonwealth Fund, http://www.commonwealthfund.org/topics/topics_show.htm?doc_id=674975Google Scholar
Klein, R. (2005), ‘The Public-private Mix in the UK’, in A. Maynard (ed.), The Public-private Mix for Health: Plus ça Change, Plus C’est La Même Chose? Oxford: Radcliffe Publishing, 4362.Google Scholar
Leatherman, S.Sutherland, K. (2008), The Quest for Quality: Refining the NHS Reform- A Policy Analysis and Chartbook, London: The Nuffield Trust.Google Scholar
Maarse, H. (2007), ‘Health reform – one year after implementation’, Health Policy Monitor, http://www.hpm.org/survey/nl/a9/1Google Scholar
Martin, S.Smith, P. (1996), ‘Explaining variations in inpatient length of stay in the National Health Service’, Journal of Health Economics, 15(3): 279304.Google Scholar
Ministry of Health, Germany (2008), Health Insurance, Bonn, Germany: Bundesministerium für Gesundheit, http://www.bmg.bund.de [English Information was removed on re-launch of website in July 2008 – copies on file with Author].Google Scholar
Ministry of Health, Welfare and Sport (2006a), Health Insurance in the Netherlands. The new health insurance system from 2006, http://www.allamreform.hu/letoltheto/egeszsegugy/kulfoldi/Az_uj_holland_egeszsegbiztositasi_rendszer_2006-(angolul).pdfGoogle Scholar
Ministry of Health, Welfare and Sport (2006b), The New Care System, Ministry of Health, Welfare and Sport, http://www.healthlaw.nl/healthcare_reform.pdfGoogle Scholar
Mossialos, E.Thomson, S. (eds) (2004), Voluntary Health Insurance in the European Union, Brussels: European Observatory on Health Systems and Policies, http://www.euro.who.int/document/e84885.pdfGoogle Scholar
Muiser, J. (2007), The New Dutch Health Insurance Scheme: Challenges and Opportunities for Better Performance in Health Financing, World Health Organization Discussion Paper 3/2007, http://www.who.int/health_financing/documents/dp_e_07_3-new_dutch_healthinsurance.pdfGoogle Scholar
National Audit Office (2007), Pay Modernisation: A New Contract for NHS Consultants in England, UK: National Audit Office, http://www.nao.org.uk/publications/nao_reports/06-07/0607335.pdfGoogle Scholar
O’Dowd, A. (2007), ‘Consultant contract has not resulted in any increased productivity’, British Medical Journal, 335: 1063.Google Scholar
OECD (2004), Private Health Insurance in the Netherlands: A Case study, Paris: OECD, http://www.oecd.org/document/25/0,3343,en_2649_33929_2380441_1_1_1_37407,00.htmlGoogle Scholar
OECD (2004), Private Health Insurance in France, Paris: OECD, http://www.oecd.org/document/25/0,2340,en_2649_33729_2380441_1_1_1_1,00.htmlGoogle Scholar
OECD (2004), Private Health Insurance in OECD Countries: The Benefits and Costs for Individuals and Health Systems, Paris: OECD, http://www.oecd.org/document/25/0,2340,en_2649_33929_2380441_1_1_1_1,00.htmlGoogle Scholar
OECD (2008), Private Health Insurance in Australia: A Case Study, Paris: OECD, http://www.oecd.org/dataoecd/5/54/22364106.pdfGoogle Scholar
OECD Health Data (2008), Health Expenditure by Financing Agent/Scheme, Private Insurance, % Total Expenditure on Health, Paris: OECD, masetto.sourceoecd.org/vl=3113507/cl=17/nw=1/rpsv/ij/oecdstats/99991012/v1n1/s1/p1Google Scholar
Or, Z., Cases, C., Lisac, M., Vrangbæk, K., Winblad, U., Bevan, G. (2010), ‘Are health problems systemic? Politics of access and choice under Beveridge and Bismarck systems’, Health Economics, Policy and Law, 5(3): 269293.Google Scholar
Poullier, J. P.Sandier, S. (2000), ‘France’, Journal of Health Policy, 25(5): 899.Google Scholar
Propper, C., et al. (2007), Did ‘Targets and Terror’ Reduce Waiting Times in England for Hospital Care?, CMPO Working Paper Series, ideas.repec.org/a/bep/eapcon/v8y2008i2p1863-1863.htmlCrossRefGoogle Scholar
Rodwin, V. G. (2006), ‘The Health Care System Under French National Health Insurance: Lessons for Health Reform in the United States’, in V. G. Rodwin (ed.), Universal Health Insurance in France: How Sustainable? Washington DC: Office of Health and Social Affair, Embassy of France, 59–77, wagner.nyu.edu/health/universal.pdfGoogle Scholar
Sandier, S., Paris, V.Polton, D. (2004), Health Care Systems in Transition: France, Brussels: European Observatory on Health Systems and Policies, http://www.euro.who.int/document/e83126.pdfGoogle Scholar
Sécurité Sociale (2007), Les comptes de la sécurité sociale: Résultats 2006, Prévisions 2007 et 2008, La Documentation française, http://www.ladocumentationfrancaise.fr/catalogue/9782110973443Google Scholar
Sécurité Sociale (2008), La participation forfaitaire de 1 Euro, France: Sécurité Sociale l’Assurance Maladie, http://www.ameli.fr/assures/soins-et-remboursements/ce-qui-est-a-votre-charge/la-participation-forfaitaire-de-1-euro.php?&page=2Google Scholar
Swedish Medical Association (2003), Working in Sweden; Information for Doctors from EU/EEA Countries, Swedish Medical Association, http://www.lg.se/upload/epi/lg/pdf/2005/working_in_sweden.pdfGoogle Scholar
Tuohy, C. H., Flood, C. M.Stabile, M. (2004), ‘How does private finance affect public health care systems? Marshalling the evidence from OECD nations’, Journal of Health Policy, Politics and Law, 29(3): 367368.Google Scholar
Williams, S.Buchan, J. (2006), Assessing the New NHS Consultant Contract – A Something for Something Deal? London: King’s Fund, http://www.kingsfund.org.uk/publications/kings_fund_publications/assessing_the.htmlGoogle Scholar