Canada could take health-care lessons from Europe, Australia: study

Posted on in Health Policy Context

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Nov 28, 2011.   Tom Blackwell

Canada should take some lessons from the largely overlooked health-care systems of Europe and Australia and shift to a “consumer-driven” culture that gives patients more choice in medical services, urges a novel new take on this country’s much-dissected medicare woes.

In a white paper to be released Monday, researchers at the University of Western Ontario analyzed seven other industrialized countries and picked out ideas they say could help governments here fix spiralling health costs and chronic service shortcomings.

Many of those countries let patients pick and choose the services they get through private health insurance companies.

Whenever Canadians size up their system against others now, they typically look south of the border, missing out on important innovations further afield, said Anne Snowdon, head of the International Centre for Health Innovation at Western’s Ivey business school.

“We’re always comparing ourselves to the U.S.,” she said in an interview. “But when you look across OECD countries, really the U.S. is not the benchmark you want to compare your system to.”

“It’s really the other national health systems, which have similar structures to Canada, but perhaps much better outcomes,” Prof. Snowdon said.

A growing list of academics, think-tanks and advocacy groups have lately offered up their prescriptions for treating the health-care system’s swelling costs, long waiting lists and health-professional shortages, though some say predictions of financial breakdown are exaggerated.

The Ivey study did encompass the United States but focused more on six other countries: Britain, Germany, the Netherlands, France, Switzerland and Australia, most of which, it said, get better bang for the health-care buck than does Canada.

All of those nations have universal systems that ensure access to health care for all, but only Canada’s funds necessary medical services solely through tax dollars.

There seems little evidence that allowing a purely private tier of health care would do much to contain costs or improve service, but a lot could be done short of that, said Prof. Snowdon.

Most dramatic of the recommendations is that Canada learn from the several European countries that ensure universality, but allow people to buy health insurance from a choice of up to 180 private insurers to cover all or part of their care.

Countries like Germany and Switzerland ensure no one has to pay more because they are sicker, said Ms. Snowden. Patients, however, can often choose a set of health services that best meets their needs, whether they have a chronic disease like diabetes or are generally healthy.

Though there is a shortage of empirical evidence in any of the countries on what works, evidence suggests that such a system encourages patients and doctors to better manage their health, curbing the likelihood people will end up in an emergency ward or pricey acute-care hospital bed, the report said.

It might not be easy to import that system wholesale to Canada, but the country should move from a culture where patients are told what treatment they can or cannot have, to one where they direct their own care, said Prof. Snowdon.

“What I felt was quite striking across a number of these other countries is the role of consumer choice,” she said. “As soon as consumers start to select and choose … then you introduce into those systems some element of competition. Then the providers for those services suddenly need to respond to consumer demand, or lack thereof.”

Canada also needs to redirect its focus from acute care hospitals to a system that concentrates on managing and preventing chronic illness, she said, citing a British “virtual ward” system that delivers care to many elderly and chronically ill in their homes, avoiding admission to hospitals and the risks that come with that.

Prof. Snowdown’s paper also recommends a national strategy for encouraging innovation in health care and making sure good ideas are implemented widely.

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