Imagine a world where you have to wait six months or more for an appointment to see a dentist. Imagine having to drive 700 kilometres to buy medicine for asthma or for a simple headache, because there is no pharmacy open after 6 p.m. on weekdays in your home city — a city of some 300,000 inhabitants.
If you think such access problems are far-fetched for a modern economy like ours, think again. They actually exist right now, or existed very recently, in other industrialized countries.
Of course, access problems are nothing new in our public health-care system. The recurring difficulties with which Canadian patients are faced, such as overcrowded emergency rooms and the inability to see a doctor when needed, regularly occupy the front pages of our daily newspapers.
In the public system’s shadow, however, there exist other areas of health care in Canada that are mostly financed and delivered by private means. These areas work well, but don’t always get the credit they deserve.
Take dental care for instance, which is essentially a private-sector matter in our country. Canada is among the OECD countries with the highest proportion of private funding. Yet in contrast to the public health-care system, dental clinics are very accessible. Waiting times to see a dentist are minimal to nonexistent.
Three out of four Canadians visit a dental clinic annually, and 86 per cent do so at least once every two years. In the early 1970s, barely half of the population consulted a dentist on an annual basis. Along with increased access, the dental health of Canadians has improved dramatically in recent decades and compares favourably with that of other industrialized countries’ populations. The vast majority of patients today, fully 85 per cent of the population, consider their dental health to be good, very good or excellent.
In Finland, where nearly half of dentists work in public facilities, the system continues to grapple with substantial failings, despite a massive injection of funds since the start of the new millennium. Barely one in four Finns thinks that the public dental centres in the municipality where he or she lives provide a good level of availability. Between 2006 and 2012, more than 13,000 people on average had been on a waiting list for dental services in the public system for more than six months. These access problems are not due to a lack of human resources, since Finland has 40 per cent more dentists as a proportion of the population than Canada.
In Australia, dental services are also offered both in private clinics and in public facilities. Public spending on dental care more than doubled from 2006 to 2011, growing by an average of 18 per cent annually. Despite these increases, as many as 400,000 adults are on waiting lists across the country, according to a recent inquiry report from the Australian Parliament. In some regions, patients are forced to wait from two to five years before gaining access to a dentist in the public system.
Canada’s pharmacy sector is another one that works like any normal industry. All community pharmacies in Canada are for-profit businesses, which almost nobody complains about. More than half of Canadians consult a pharmacist every week, in the vast majority of cases without having to make an appointment beforehand. Practically all patients are able to receive their prescriptions within a matter of minutes.
This is not the case in all countries, however. In several European countries, governments impose excessive regulations on pharmacies, thereby discouraging competition and seriously penalizing consumers. For example, pharmacy chains are illegal in nearly two-thirds of EU countries.
In Sweden, the pharmacy sector was a government monopoly from 1971 to 2009. Consequently, it was among the countries with the lowest number of pharmacies by population, with barely one outlet per 10,000 inhabitants, about a third as many as in most Canadian provinces. State pharmacies offered 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 closed down completely for the summer.
Sweden has since profoundly liberalized this sector and the number of pharmacies has skyrocketed as a result, increasing more in the following four years than in the previous 30. In addition to the hundreds that were privatized, 374 new private pharmacies entered the market, thereby improving access for the inhabitants of all regions.
The effectiveness and accessibility of the health services provided by the private sector result primarily from the market mechanisms that govern them, namely entrepreneurship, competition and patients’ freedom of choice. We should not be surprised to find that these mechanisms are largely absent in the public health-care system. Yet it is these mechanisms that ensure that patients remain at the centre of care-providers’ concerns. We should keep that in mind when thinking of how to reform our ailing public system.
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.