GOLDSTEIN: A mediocre and expensive healthcare system needs a reform: report

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Canadians are paying too much for too little health care because the federal government prohibits provinces from reforming an expensive and failing system, according to a new study from the Fraser Institute.

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The fiscally conservative think tank report says that while Canada ranks fifth highest in age-adjusted per capita spending on health care among 28 comparable countries with universal health care systems, Canada’s performance is “poor to moderate.” .

The study, Less Ottawa, More Province, 2021: How Decentralized Federalism Is Key to Health Care Reform , says that despite high spending, Canada is ranked 26th out of 28 in the number of physicians (2.8 per 1,000 people); 25th out of 26 in acute care hospital beds (2.1 per 1,000) and 24th out of 28 in psychiatric beds (0.4 per 1,000).

Canada is ranked 21st out of 24 countries in the number of MRIs (10.5 per million population); 22 out of 26 in CT scans (15.2 per million) and 17 out of 24 in PET scans (1.6 per million).

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Canada’s medical wait times are the longest of 10 comparable countries with universal health care systems that are members of the Organization for Economic Cooperation and Development.

“Taken together, these data demonstrate that Canada has substantially fewer capital and human medical resources than many peer jurisdictions that spend comparable amounts on healthcare,” the study concludes.

According to study co-author Ben Eisen, “COVID-19 has exacerbated two of the most significant current public policy challenges facing Canada: deteriorating government finances and the comparable underperformance of our healthcare system.”

Without reforms, things will only get worse, he said, due to the increasing health expenditures needed to serve Canada’s aging population.

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Health spending is the largest individual program spending in all provinces, ranging from 36.7% in Quebec to 38.5% in New Brunswick, 38.6% in PEI, 38.9% in British Columbia, 39.6% in Saskatchewan, 39.6% in Manitoba, 40.3% in Alberta, 42% in Ontario, 46.1% in Newfoundland and Labrador, and 46.6% in Nova Scotia.

The study argues that the main impediment to reform is the Health Canada Act, which prohibits provinces from implementing cost-sharing measures with patients, such as coinsurance, deductibles and copayments.

While these policies, designed to ensure efficient use of the health care system by patients, are common in countries with universal health care systems, the Health Canada Act stipulates that federal transfer payments to the provinces for health care – $ 40.4 billion last year alone – will be withheld dollar for dollar from whichever province implements it.

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Critics argue that changing this would bring “American-style two-tier healthcare,” which is absurd because many countries comparable to Canada with universal healthcare systems have co-pay mechanisms, spend less money per capita on healthcare than we do, and have better results in health care.

In fact, the US was not included in Canada’s comparison with other countries because it does not have universal health care.

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“Cutting the shackles on healthcare transfers from Ottawa … while upholding the principles of universality and portability would free up the provinces to experiment and reform healthcare delivery and financing,” Eisen said.

He said the Jean Chretien government did this with federal transfers to spend on welfare programs in the 1990s, reducing the amount of payments but giving the provinces more freedom to offer programs like workfare, dramatically reducing the number. Canadians on welfare.

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