If there’s one thing that Ontario voters seemed to agree on during the 2018 election, it was that a wealthy province such as ours shouldn’t be stuffing sick people into hospital corridors. The Progressive Conservatives say they can fix this “hallway health care” problem through innovation and so-called efficiencies. The New Democrats argue that we need to raise taxes to pay for expanded services.
But there’s a better way: allow people with means to pay for quicker access to care, whether out of pocket or through private health insurance. While Ontarians may support single-payer universal health care, evidence from overseas demonstrates that allowing wealthy people to pay for private care results in shorter wait times for everyone.
Shawn Whatley, a doctor who practises in Mount Albert, teaches at the University of Toronto, and is a former president of the Ontario Medical Association, says Canadians often assume that giving people the option to pay for private medical care would mean copying the American system, one that is both expensive and inequitable.
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“They say, ‘We don’t want to be like the States. I think most people would agree with that,” Whatley says. He adds, however, that many people don’t realize Australia and some Western European countries have free universal health care but also allow a small amount of privately funded care — and wait times in those places aren’t nearly as long as in Ontario.
Yanick Labrie, a health-care economist and senior fellow at the Fraser Institute, agrees. “We tend to think if we allow private, we’re going to have the rich getting access in a timely fashion and the rest of us having to wait longer,” he says. “It’s not what we’ve noticed in Europe.”
A 2016 study from the Commonwealth Fund, a U.S. think-tank, provides some backing. It asked thousands of people in eight Western nations — including residents of several Canadian provinces — how long they typically wait to be seen in hospital. Ontario’s wait times were higher than those of all eight countries surveyed: 24.5 per cent of Ontarians reported having waited four hours or more to see a doctor in a hospital emergency room; just 1.5 per cent of respondents in France, 3.3 per cent in Germany, 4 per cent in the Netherlands, and 7.9 per cent in the United Kingdom said the same thing. Ontario also lagged behind all eight countries in wait times for non-emergency surgeries and specialist treatment.
A 2017 German study examining disparities between that country’s public and private systems offers more evidence that two-tiered systems can be more efficient for all. Privately insured patients, who make up approximately 11 per cent of the population, wait on average a day and a half for non-emergency MRIs; publicly insured patients wait on average just under five weeks. In Ontario, wait times for non-emergency MRIs average eight weeks (and in several regions stretch beyond 12 weeks).
Another possible benefit of private payment: it could make the public system more accountable, Whatley explains, because people would have something to compare it against. “In Sweden, they have a wait-time guarantee where, if the public system can’t provide you with your hip replacement in a certain amount of time, then the public system will pay for your hip replacement in the private system,” he says. “It’s actually driving access.”
And while advocates of single-payer health care may contend that allowing some people to pay privately for treatment would cause a mass exodus of doctors from the public to the more lucrative private system, that hasn’t happened in Germany. According to the Fraser Institute: “Nearly all hospitals (public and private) provide care to both SHI and PHI patients” — that is, publicly and privately insured people — “with 99 per cent of all hospital beds being accessible to SHI-covered patients.”
As it stands, many wealthier Ontarians are already paying for private care — they’re just doing so in other countries. The Fraser Institute estimates that between 22,352 and 26,513 Ontarians sought non-emergency medical care outside Canada in 2016.
Labrie says that if those people had been allowed to spend their money in Ontario, it would have generated new taxable economic activity. “The only reason why you wouldn’t have an increase in tax revenues would be if you have tax breaks,” he says, noting that some countries, including Australia, offer tax breaks on private insurance because they want to facilitate a parallel private system that can save the treasury money.
Ontario could opt to allow and tax private medical services and plow the proceeds directly into the public system to alleviate wait times. “There are thousands of ways to set this up where it could be good for everybody,” Whatley says. “I would hope that we would start by asking the question: What do all patients want?” he adds. “They don’t want access to a wait-list. They want access to care.”
Josh Dehaas is a freelance journalist whose work has appeared in Maclean’s and the National Post, among others.
To read the case against private, for-profit health care in Ontario, click here.