Opinion: To fix Canadian health care, let’s try the Dutch model

Paramedics roll out a stretcher from the emergency department at Mount Sinai Hospital, in Toronto, on January 13, 2021.Cole Burston/The Canadian Press

Ake Blomqvist is a Research Associate Professor at Carleton University and a Health Policy Scholar at the CD Howe Institute, where Rosalie Wyonch is also a Senior Policy Analyst.

The pandemic has revealed the fragility of Canada’s health care system, and there is growing recognition that changes are needed to curb rising costs and promote efficiency. But in a health care financing model like ours, change is difficult, especially when responsibility is distributed among various political masters. We should try a different approach, based on a model like the Netherlands, which scores better on criteria such as completeness of coverage and waiting times.

Canadian health insurance, of course, is often described as a “single payer model” because everyone in a given province or territory is covered by the same government plan. Doctors and hospitals derive virtually all of their income from the government plan in the province or territory in which they practice.

This current system is outdated. Canadian Medicare was designed more than 50 years ago for a simpler world in which most curative care could be provided by general practitioners in solo practice. With today’s complex medical and pharmaceutical technology and a plethora of specialized professionals and services, efficient care requires a different, more collaborative and integrated approach, with different payment methods.

Adapting the health care system to evolving technology would benefit from competitive forces in a multi-payer financing model (like the one in the Netherlands) where consumers can choose between different insurance plans. These plans are able to compete through innovative new arrangements that affect the way their clients’ health care is managed.

Canada should seriously think about building on the Dutch example and modifying our universal health insurance model so that it also allows consumers to choose between alternative competing plans, whether public or private. The Dutch multi-payer model of “managed competition” preserves the principles of universal insurance and an equitable distribution of health care costs. Universality is ensured through compulsory insurance and equity is achieved through the requirement that plans have open enrollment.

In a multipayer system, insurers can negotiate with providers on financing methods and other contractual provisions that give them incentives to make more cost-effective decisions when serving their insured patients. Consumers will choose plans that offer what they believe to be the best combination of cost and expected quality of care; only suppliers that offer acceptable working conditions and remuneration will be incorporated. As a result, the health system can adapt and become more efficient thanks to the voluntary decisions of consumers and providers, without the need for politically difficult reforms.

Changing the way healthcare is delivered to patients is difficult. Modernization of a publicly funded single-payer system that covers all patients and providers can only happen as a result of initiatives by politicians, and reforms to improve the efficiency of the system will always be controversial. More efficient delivery of health care generally means less spending on some services, and therefore less income for those who provide them.

In Canada, health policy is also complicated by divisions in health care jurisdiction between the federal and provincial levels of government, and by those who think we should use health care policy to show how Canadians are more committed to the equity that our neighbors around the world. south. In a multi-payer system, change can happen gradually and with less controversy.

The multi-payer system that most Canadians are probably familiar with is, of course, that of the United States, whose system is very expensive and leaves many people uninsured. But the United States is an exception. Countries like Switzerland, Germany, Israel and the Netherlands are examples of multi-payer financing systems where costs are much lower than in the US and health insurance coverage is universal (and includes more than the system). Canadian, such as prescription drugs). One way to make the proposal to transform Canada’s system into a multi-payer model less controversial would be to treat existing provincial health insurance plans as a default option, meaning that everyone would continue to be covered by their provincial plan at unless they opt out and obtain coverage through an approved substitute plan.

Canada’s health care system faces major challenges ahead, including the need for more physicians and health professionals and the growing demand for their services from aging baby boomers. To make the system more efficient and sustainable, we need structural reform. A Dutch-style multi-payer managed competition financing system would give us a better chance of achieving this. We should try it.

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