While many Canadians struggle to access health care, the Second Street think tank recently unearthed a surprising number of Canadians who had more than 100 doctor visits in a single year. This suggests that some frequent fliers consume many services, while others languish with reduced access or none at all.
To help better manage excess demand and avoid waste, the provinces should follow the lead of universal health-care countries worldwide and implement some form of cost-sharing for health-care services.
The logic behind cost-sharing
For many Canadians, paying a small fee for health care seems unreasonable. But the logic is simple. Patients make more informed decisions about when and where to access the health-care system when they face even a small cost to do so. And as a result, the demand for health-care services declines — as much as 20 to 30 per cent, based on studies of cost-sharing and the experiences of other universal health-care countries — which frees up resources for others who struggle to see a doctor, or saves money for taxpayers, or both.
Canada in the minority
Canada’s provinces are in a distinct minority. Among 28 countries with universal health care, only six (Canada, the United Kingdom, Spain, Denmark, Czechia and Hungary) don’t have some form of cost-sharing for physician and hospital services. And every top-performing universal health-care system (including Australia, Germany, the Netherlands, Switzerland and Sweden) requires patients to share the cost of care. Crucially, these countries also provide exemptions for lower-income patients, pregnant mothers, children and those with specific illnesses.
Small fees, big impact
To encourage more informed patient decision-making, the fees need not be large. For instance, Swedes pay fees of between 100 and 300 SEK (equivalent to between $15 to $44 Canadian) for primary care and up to 400 SEK ($59) for specialists. Regardless of the specific number, studies show the greatest impact of cost-sharing is at the lower end of the fee scale, suggesting that even a small fee can remind people that health-care use comes with costs and trade-offs.
Federal government acknowledges value
The federal government, despite discouraging provinces from implementing cost-sharing under the threat of clawbacks in health-care cash transfers as codified in the Canada Health Act, seems to understand the value of this approach. In May, the government introduced a fee for “supplementary and prescription health coverage” in its program for asylum seekers and refugee claimants and expects to save $140 million this year from the policy change. Provinces, if freed from federal financial constraints, could apply that same lesson to physician and hospital services — again, like the large majority of universal health-care countries.
Time for change
While some Canadian patients see doctors a surprising number of times each year, many others struggle to access health care. Asking patients to share the cost of their health care, with exemptions for vulnerable populations, would help fix that problem. It’s time Canada stopped being so unusual and started following the lead of higher-performing universal health-care countries.
Nadeem Esmail and Mackenzie Moir are analysts at the Fraser Institute
