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31 March 2015March 31, 2015

The Other Health Care System: Four Areas Where the Private Sector Answers Patients’ Needs

Research Paper describing four areas of the health care industry in Canada that are largely private and that work well

The Other Health Care System: Four Areas Where the Private Sector Answers Patients’ Needs

The recurring problems with which Canadian patients are faced, such as overcrowded emergency rooms and the inability of seeing a doctor when you need to, regularly occupy the front pages of our daily newspapers. In international rankings, Canada systematically finds itself at the bottom of the pack, among the countries where waiting times for health care are the longest. Yet there exists another health care system, an essentially private one that works well but that does not always get the credit it deserves. This Research Paper provides a picture of four areas where the private sector responds promptly and effectively to the needs of Canadians: seniors’ housing and care, pharmacy services, dental care, and eye care.

Media release: How would you like to wait six months to see a dentist?

Links for individual chapters

Chapter 1 - Private Seniors' Housing and Care: The Quebec Example
Chapter 2 - Pharmacies in Canada: Accessible Private Health Care Services
Chapter 3 - Dental Care in Canada: The Private Sector Responds Effectively to Demand
Chapter 4 - Eye Care in the Private Sector: Innovation at the Service of Patients

 

Related Content

Why dentists don't have waiting lists (Montreal Gazette, April 3, 2015)

Les avantages du privé (La Presse, April 7, 2015)

Why you never wait to see a dentist (National Post, April 17, 2015)
Interview (in French) with Yanick Labrie (98,5 FM, March 31, 2015)  

Research Paper prepared by Yanick Labrie, Economist at the MEI.

Executive Summary


The recurring problems with which Canadian patients are faced, such as overcrowded emergency rooms and the inability of seeing a doctor when you need to, regularly occupy the front pages of our daily newspapers. In international rankings, Canada systematically finds itself at the bottom of the pack, among the countries where waiting times for health care are the longest.

Yet there exists another health care system, an essentially private one that works well but that does not always get the credit it deserves. This system provides services that are much more accessible and leaves very few people dissatisfied. This Research Paper provides a picture of four areas where the private sector responds promptly and effectively to the needs of Canadians: seniors’ housing and care, pharmacy services, dental care, and eye care.

Quebec is the Canadian province with the highest number of private residential housing spaces for seniors. While the sector has received a lot of media attention in recent years, many of its successes have unfortunately gone unnoticed.

Of the seniors’ housing spaces available in Quebec, around 70% are provided by private residences. These serve a clientele that is mostly made up of individuals who are autonomous or who have only slightly reduced autonomy. Yet experience shows that private facilities have the means to provide quality care for seniors with substantially reduced autonomy. A recent study found that the services provided by private facilities within this context were of a higher overall quality than those provided by public CHSLDs.

The pharmacy sector, contrary to the public hospital network that seems to be in a perpetual state of crisis, functions like a normal industry. We don’t see headlines in the media referring to “lengthening wait times for pharmacy services” or to the inability of a substantial portion of the population to find a “family pharmacist.” Canadian pharmacies distinguish themselves by their exceptional accessibility. Most pharmacies are open seven days a week, and some are open 24 hours a day.

This is not the case in all countries, however. For example, before liberalization, Sweden’s government monopoly pharmacies offered clients very limited opening hours: from 10 a.m. to 6 p.m. Monday through Friday, and from 10 a.m. to 2 p.m. on Saturday. Not a single pharmacy was open on Sunday, and many even closed down completely for the summer.

We tend to take it for granted that pharmacies will continue to offer quality services that meet the needs of the population regardless of the governmental rules that are imposed upon them. The experiences of numerous European countries, however, reveal the dangers of excessive government regulation.

Dental care is also essentially a private sector matter in Canada, and once again, contrary to the public health care system, dental clinics are very accessible and waiting times to see a dentist are minimal to nonexistent. Canada is among the OECD countries with the highest proportion of private funding for dental care, and the vast majority of patients today, fully 85% of the population, consider their dental health to be good, very good or excellent.

Nonetheless, for the past few years, several interest groups have been calling for increased public funding for dental care in Canada. International examples show us, however, that more government funding does not necessarily improve the accessibility of services. On the contrary, we find the establishment of rationing policies and the appearance of long waiting lists to obtain required treatment.

In Finland, wait times in 2012 were over a month long in 85% of public dental centres. In Australia, waiting times for public dental services are often between two and five years in some areas, with up to 400,000 adults on waiting lists across the country. Canadians were 30% more likely to have visited a dentist in the past 12 months than Australians.

Finally, over 90% of total spending for eye and vision care in Canada comes from private sources. The optometry sector has become more and more competitive over the years, with the number of optometrists growing by 67% between 1997 and 2012, far outpacing population growth. Manufacturers and retailers of lenses, frames and other vision devices also operate in a highly competitive, international market, which leads to improvements in product quality, and limits price increases.

Furthermore, over the past decade, laser surgery has improved the vision of hundreds of thousands of people in Canada. A growing number of clinics now compete to offer this service, and the results are convincing. Whereas in the early 2000s, a standard LASIK procedure cost around $5,000 for both eyes, the price now fluctuates between $1,000 and $2,000.

The lesson is clear: In those areas of health care where entrepreneurial initiatives are encouraged, we can see that the market is dynamic, innovations abound and the quality of services and treatments is constantly improving.

Introduction

In recent years, many studies and reports have highlighted the scope of our difficulties getting access to care in the public health system. The recurring problems with which Canadian patients are faced, such as overcrowded emergency rooms and the inability of seeing a doctor when you need to, regularly occupy the front pages of our daily newspapers.

Delays in receiving services in the public system have become a structural problem in all of the provinces over the years. In international rankings, Canada systematically finds itself at the bottom of the pack, among the countries where waiting times for health care are the longest.

Patients, often running out of options, seem increasingly concerned by wait times for required treatments that are growing longer.(1) A majority of Canadians are of the opinion that major reforms are called for to improve the situation. According to a recent study on the population’s health care perceptions and experiences, nearly two in three Canadians believe that the system requires fundamental changes or needs to be completely rebuilt.(2)

In the public system’s shadow, however, there exists another health care system, an essentially private one that works well but that does not always get the credit it deserves. This system provides services that are much more accessible and leaves very few people dissatisfied. When polled, Canadians say they are much more satisfied by the services they receive in dental clinics and pharmacies than by those they receive in public hospitals. According to a survey carried out by Forum Research, the satisfaction rates of patients for services received from pharmacists (93%) or dentists (85%) are around twice as high as for services received in hospital emergency rooms (45%) (see Figure I on iedm.org).(3)

This Research Paper provides a picture of four health related areas where the private sector responds promptly and effectively to the needs of Canadians. These areas cover pharmacy services, dental care, eye care, and seniors’ housing and care.

We often mistakenly believe that these areas are fundamentally different from the rest of the health care system and that they just naturally work well, but this is not the case. As we shall see, the effectiveness and accessibility of the services provided in these areas in Canada result primarily from the market mechanisms that govern them: competition between providers, the profit motive, and patients’ freedom of choice. In countries where these mechanisms are abandoned, we can witness the same access problems and waiting lists that afflict the public health care systems of each of the Canadian provinces.

Notes

1. See among others Nanos Research, Wait Time Alliance - Wait Times Project Summary, Poll commissioned by Wait Time Alliance, September 2014; Stuart N. Soroka, Canadian Perceptions of the Health Care System, A Report to the Health Council of Canada, February 2007, p. 3.
2. Mike Benigeri and Olivier Sossa, Perceptions et expériences des soins de la population : le Québec comparé, Results of a 2013 international study of health policies by the Commonwealth Fund, Health and Welfare Commissioner of Quebec, January 2014, p. 14.
3. Forum Research, Saskatchewan, Manitoba, New Brunswick Top Health Care Satisfaction Poll Overall, June 2012.

Read the Research Paper on iedm.org.


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