How would you feel about having to wait a month or more for an appointment to see a dentist? What if all pharmacies were closed weekday evenings and most of the weekend?
Such access problems actually exist already in other industrialized countries. The pharmacy and dentistry sectors are not fundamentally different from other areas of health care, after all. The reason they provide accessible services that respond effectively to the needs of patients here in Canada has everything to do with the fact that here in Canada, they’re largely private.
The pharmacy sector, for instance, functions just like any other normal sector — which is why we don’t have “lengthening wait times for pharmacy services.” Pharmacies are by and large open seven days a week, and sometimes even 24 hours a day.
In Sweden, however, the pharmacy sector was a government monopoly until 2009. As a result, Sweden was among the countries with the lowest number of pharmacies in the world by population, with barely one branch per 10,000 inhabitants (about a third as many as in Canada). Opening hours were from 10 a.m. to 6 p.m. Monday through Friday, and from 10 a.m. to 2 p.m. on Saturday. None were open on Sunday, and many closed down for the summer.
What happened when Sweden finally liberalized the sector? The number of pharmacies skyrocketed, increasing by 46 per cent in just four years, and opening hours expanded, too.
Dental care is another area that’s basically private in Canada, and waiting times to see a dentist are just about nonexistent. Three in four Canadians visit a dentist yearly, among the highest rates for OECD countries, and fully 85 per cent of the population consider their dental health to be good, very good or excellent.
What does greater government involvement buy? In Finland, wait times in 2012 were over a month long in most public dental centres. In Australia, the wait is often between two and five years in some areas, with up to 400,000 adults on waiting lists across the country. Not surprisingly, Canadians are 30 per cent more likely than Australians to have visited a dentist in the past 12 months.
Eye care in Canada is also largely private, with clear benefits for patients. Corrective laser eye surgery in particular shows the positive effects of market competition: The cost of a standard LASIK procedure fell from some $5,000 for both eyes in the early 2000s to between $1,000 and $2,000 today.
In Quebec, around 70 per cent of seniors’ housing spaces are also supplied by the private sector, which provides alternatives that are less expensive than the public sector, and better adapted to the varied needs and preferences of the population.
Whatever the sector, when entrepreneurial initiative and competition are given room to operate, we get new and better products and services, and downward pressure on prices. But certain interest groups would like to see more government involvement in such areas, chipping away at the freedom that allows them to work so well.
We should instead think of reforming our ailing public system using these sectors as a model. If we did, we could ease emergency room crowding and bring down the wait time between seeing a general practitioner and getting treated by a specialist from its current, unacceptable average of over 18 weeks. Rather than messing with what works, let’s get serious about fixing what doesn’t.
Yanick Labrie est économiste à l’Institut économique de Montréal et auteur de «L’autre système de santé – Quatre domaines où le secteur privé répond aux besoins des patients». Il signe ce texte à titre personnel.