Health: A mixed delivery model based on criteria established by the government would promote better access to health care, says the MEI

Montreal, October 30, 2025 – Reforming Canada’s healthcare systems in order to make private provision accessible within the public health insurance scheme would help improve access to care for Canadian patients, recommends an MEI Research Paper released this morning.

“The best performing universal healthcare systems in the world are not those where the public sector has a monopoly,” says Professor Marcel Boyer, distinguished senior fellow at the MEI and author of the paper. “It is rather those that apply the principles of competition to place the patient at the heart of the decision-making process which achieve the best results.”

Among the healthcare systems in advanced economies, the public monopoly over the delivery of care in effect in Canada’s provinces is the exception.

Most healthcare systems instead rely on a mixed model, combining public, private for-profit, and private non-profit hospitals in order to ensure access to care. In most of the countries studies, the care provided in these facilities is covered by universal insurance—similar to public insurance in Canada.

In France, for instance, private hospitals—for profit and non-profit—represented 55 per cent of all hospitals in 2023 and accounted for 39 per cent of available beds in the country.

The for-profit sector there is responsible for 55 per cent of surgical operations, 42 per cent of medical care and rehabilitation, and 22 per cent of psychiatric hospitalizations.

“By protecting the public sector from all competition, our healthcare system has lost the incentive to innovate when it comes to management methods,” says Professor Boyer. “As governance is subject to very few performance incentives, we are now facing a situation in which the substantial resources deployed are administered neither effectively nor efficiently.”

In order to correct this, the researcher recommends that the government focus on identifying needs, arbitrating between groups, designing funding methods, and managing contracts and partnerships.

These are roles that government already carries out in part, combining block funding and a health insurance plan to finance healthcare activities, all while establishing the healthcare needs covered by its services.

The competitive sector, for its part, would be responsible for mobilizing the appropriate technologies, human resources, and organizational structures, as well as ensuring the production and provision of healthcare goods and services.

“In France, Germany, and South Korea, this separation of roles between the government and the independent competitive sector exists at various levels and serves patients effectively,” adds Professor Boyer. “By implementing such a reform in Canada, we could finally recentre decisions on the patient.”

The MEI Research Paper is available here.

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The MEI is an independent public policy think tank with offices in Montreal, Ottawa, and Calgary. Through its publications, media appearances, and advisory services to policymakers, the MEI stimulates public policy debate and reforms based on sound economics and entrepreneurship.

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