Is Canada odd? A comparison of European and Canadian approaches to choice and regulation of the public/private divide in health care

Abstract

Choice is often touted as a means for change within health care systems. Yet 'choice', in this context, takes at least three distinct forms: choice between providers within a publicly funded health care system; choice between competing insurers within a universal plan; and, lastly, choice as between privately financed health care and universal public coverage. In Canada, it is this last form of choice that is under active debate; particularly in light of the Supreme Court of Canada's decision in Chaoulli, which found a regulation banning private health insurance for medically necessary care was unconstitutional. The argument is frequently made that Canada is an outlier from other countries in having regulation that effectively precludes this kind of choice. This issue is likely to become of concern again in upcoming constitutional challenges where applicants are looking to overturn through judicial challenges Canada's medicare system. This article tests that argument of whether Canada truly is 'odd' from a comparative policy perspective by exploring regulation of choice of privately financed health care in several European countries - the Netherlands, Germany, Sweden, England and France. We highlight commonalities as well as differences, showing the extent to which these countries employ regulation to fetter growth of a large privately financed sector. The article's thesis is that Canada, in employing more intrusive forms of regulation, is not an outlier per se but at one point in a regulatory spectrum.

International models of health systems financing

“…Sweden and The United Kingdom are tax-financed and allow a two-tier system for physician/hospital care. France is a combination of tax financing, social health insurance funds, and private insurance to cover co-payments and other out of pocket costs [7] .…”

“…The system is primarily tax-financed and the NHS's mandate is to deliver universal and comprehensive access to health care mostly free at point of service [7] .…”

“…It mandated the insurance companies to accept all individuals and provide a basic package of benefits. The new regulations also prohibited insurance companies from rating or charging additional premiums tied to health risk for basic coverage [7] .…”

“…There are several plans that act independently from the central government. The system is complex in that both tax and private financing is used to fund insurance plans [7] .…”

“…Principles include the concept that all persons should receive consideration for health services based on need and capacity for self-advocacy. The provision of health services are held to the principle of cost efficiency [7,24] .…”