Hybrid public-private healthcare: a solution that requires regulation

by 09 Sep 2016
by Leo Almazora

A heated debate often benefits from a credible outsider’s perspective. In the case of the reignited argument over Canada’s healthcare system, a professor from the United States who has studied healthcare systems all over the world has offered his two cents’ worth.

Victor Rodwin, a professor of health policy and management at New York University, recently told CBC Canada that a combined public-private healthcare system, similar to the one in Germany, could shorten patient wait times if properly implemented.

"There's no perception of great wait times comparable to what you find in Canada. If you have a little bit more money in Germany... you can see doctors who extra-bill. There's no perceived problem of rationing... because if there's no room in the public sector, you go to the private sector," he explained.

Rodwin described the German system as one where different systems can pick up the slack from each other. It includes private supplementary insurance as well as private non-profit and for-profit hospitals. Private doctors are free to work in public hospitals and individuals with their own private insurance can select their preferred doctor and services.

He clarifies that the success of the German system is supported by a backbone of regulatory oversight. “It requires a long institutional infrastructure that's been built up to enforce that kind of system ... You don't just change systems overnight,” he said.

Another question that bears asking, Rodwin said, is whether private billing is the cure-all to long patient wait times. It’s possible that the delays and backlogs Canadians endure are due to an unfavorable ratio of doctors or hospital beds to patients.

He also suggested other systemic solutions such as different appointment procedures or telemedicine. Canadian Health Minister Jane Philpott, who is pushing for a more effective healthcare system, has also asserted that innovation is necessary to improve outcomes all over the country.

Godwin also questions whether German healthcare measures can be transplanted successfully into the Canadian system. “Even if these systems operate well, it doesn't necessarily mean they will operate well in Canada,” Rodwin pointed out.

One risk he sees is inequity. Germany’s public-private hybrid system, he observed, suffers from greater inequalities in access to care compared to Canada, which boasts one of the most equitable healthcare systems in the world. Protecting this status won’t be easy if a hybrid system is put in place, which underscores the importance of regulation.

“In principle, there's nothing wrong with [allowing private healthcare] as long as the system is properly regulated. If you simply unlock the system and let doctors extra-bill, you have a risk of creating far greater inequality in a system which is known throughout the world as meeting the ideals of an equitable healthcare system.”


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