The Foundations of the Canadian Health Care System

The Founding principle of the Canadian health care system is solely based on the need for service, and not the ability to pay. The topic of Health Policy in Canada is often surrounded by controversial arguments and elements of conflicts. The Canadian healthcare system is often characterized as being a public one, however many would argue that this description is not accurate. On average, about one third of the services offered falls outside of the public system (Miljan, 2018). As a result, a large portion of the Canadian population are in agreement that the current health policy is in need of an urgent reform. More recently, Canadians are beginning to express their growing concerns on the state of the current system. Arguably, there are several arguments in support of a health policy reform in Canada. First, the current system falls short in delivering high quality access to healthcare in a timely manner. When compared to other Western European countries for example, Canada currently has some of the longest wait times for medical care in the developed world. Also, there is a rise in demand for health care services, which is partially due to the fact that Canada has an ageing population and an increase in expectations. As a result, the public sector is currently struggling to keep up with this high demand. According to (Miljan, 2018), within the last decade, not many issues in Canadian politics have been as prominent as health care. Primarily because Canadians believe that there is a systematic issue with the current health care system. This includes, an increase in the wait times for elective surgeries and other procedures, overcrowded emergency rooms and waiting areas, a shortage of specialist and general practitioners in several communities, which might be the result of a large percentage of Canadian doctors and nurses migrating to other countries such as the United States, in search of jobs. Additionally, one of the most alarming issue is the restructuring and closing of hospitals which has recently become a routine. This paper will argue that Canada should privatize its healthcare system because it could reduce patient wait times (Chen et.al, 2015), allow beneficiaries with their own private insurance to pick their own doctors and services (Mayson et.al, 2019) and it would also encourage Canadian doctors to practice within Canada instead of migrating to other countries (Weil, 2006).

Waiting for treatment has become a defining characteristic of Canadian health care. As a result, one of the main arguments in support of a privatized health care system in Canada is that it would drastically reduce patient wait times (Chen et.al, 2015). In recent years, polls have revealed that Canadians are generally satisfied with their current government-funded healthcare system. However, a large percentage of the population are also in agreement with the statement that the current system is flawed. (Miljan, 2018) argues that, despite being one of the world’s leading spenders on healthcare, the Canadian health care system is within the lowest ranking when compared to other developed countries. Currently, one of the most highly debated topic in Canada and other OECD (Organization for Economic Co-operation and Development) countries, is the ongoing issue, where citizens are calling for a privatization of the health care system due to the long waiting times. In his article, (Chen et.al, 2015, p.65) mentions that “in Canada, long waiting times for elective surgeries have led to several famous lawsuits and nationwide health reform debates”. Despite the numerous steps taken by both the federal and provincial governments in Canada to address the issue of the prolonged waiting times within the public healthcare system, there still remains an issue. (Chen et.al, 2015) argues that for most Canadians, the underlying issue is not the current structure of the healthcare system, but instead the fact that Canadians are not given the choice to choose. He also argued that the implementation of a two tired system instead of the current single-payer health system would assist in alleviating this current issue. When compared to countries such as the United States for example, Canada’s current system is often describe as being unavoidable due to the fact that the entire healthcare system is universally funded (Abeney, 2015).

Initially, the implementation of the national health care plan had received enormous support from Canadians, primarily because it was considered as a cheap form of healthcare. However, due to the rising inconsistencies in the system, Canadians are now opting for a more private and reliable form of insurance. In his study (Chen et.al, 2015: p.606), concluded that on average, based on data collected from the Canadian Joint Replacement Registry, there is an estimated wait time of twenty-four months to have the procedure done. According to (Chen et.al, 2015), this is an overwhelmingly long wait, when compared to other countries such as the United States for example, whose average wait time ranges from four to six weeks. Furthermore, women seeking fertility treatment in Ontario, are sometimes placed on waiting lists, which might take months before being able to meet with a fertility specialist (Abeney, 2015). Abeney also explained that, since the inclusion of procedures such as In Vitro Fertilisation (IVF) the estimated wait times have since doubled. (Chen et.al, 2015) argues that, by implementing a private health care system, there will be an automatic shift in the demand-supply equilibrium. That is, citizens will then be given the choice of opting out of free healthcare. As result, the introduction of a private care will shift part of the demand from the current public care, thus limiting the congested wait time in the public health system.

Another highly discussed topic when considering the privatization of the Canadian health system is the freedom to allow beneficiaries with their own private insurance to pick their own doctors and services. That is, giving citizens the choice to choose their personal healthcare practitioners. (Chen et.al, 2015) argues that not only will this allow the patients to feel more secure, but it will also contribute to the development of better patient- doctor relationships. Furthermore, this will also give privately insured persons the opportunity to select the most advanced equipment for treatment (Mayson et.al, 2019). One of the most understated realization under profit driven private practice is that time is eventually assessed in monetary terms. (Khan 2019, p.10) mentions that, “as long as private systems are competitive and proving themselves better than public service open systems, the weaknesses of the public sector distribution are easily targeted as benchmarks proving private is better than public markets”. Not only will a privatized health care system be beneficial for the general public, this will also significantly benefit the medical practitioners as well. According to (LaPlante et.al, 2015), a lot of health care practitioners are adhering to the “one issue per visit” policy. He mentions that this issue has been around for a long time and is often regarded as a symptom for the “free-for-service” system, where physicians bill the government per appointment rather than draw a salary. (LaPlante et.al, 2015: p. 128), went on to elaborate that this is the way in which “more than seventy percent of Canadian doctors are paid” He argues that “a family doctor is generally paid between $30 to $40 per patient for a regular visit”. Though aspects of this might be beneficial for doctors, it is arguable to state that this system is not only inconvenient for many patients, but might also have several health risks and implications, as doctors are not thoroughly examining their patients.

In her article, (Valle, 2016) mentions that not only does privatized health care provide patients with extensive and personal care, but it also gives patients the peace of mind, knowing the exact wait times for surgery and other forms of medical treatments. She went on to further state that for most patients, this is more valued than the widespread concerns about affordability. When assessed on an international scale, the quality of Canadian health-care system is often questioned (Miljan, 2018). That is, the level of efficiency is often a cause for concern for many Canadians. Miljan mentions that, regardless of the fact that the Canadian healthcare system is often prided by several politicians, Canada has finished either ninth or tenth for several years running by the United States based commonwealth fund. She argues that based on the data collected, the main issue for this low ranking is accessibility and availability of licensed practitioners. “Most Canadians have timely access to world-class care for urgent and emergent problems like heart attacks, strokes and cancer care” (Valle 2016, p. 210). However, for more menial procedures, the typical wait times is estimated at most several months, or in some instances, several years. This wait period is considered to be unacceptable.

(Miljan, 2018) argues that one of the main reasons for the ongoing debate about Canada’s current healthcare system is based on the fact that political leaders have not been particularly helpful in educating the Canadians on the current problems being faced by the healthcare system. As a result, it is then interpreted that that the cause of this systematic issue is due to a lack of funding. However, as (Weil, 2006) stated, the issue facing the Canadian health care system is not due to a lack of funding, as Canada currently has one of the largest funded healthcare system in the Western society. According to (Chen et.al, 2015), the limitations and restrictions that are constantly being placed on Canadian physicians, are resulting in the migration of a large number of Canadian doctors to other territories where they are given the “freedom” to practice. (Weil, 2006), argues that more recently, the Canadian health care system has become a less favorable place to practice. He mentions that, not only is the current system underfunded, but it is also strained. Physicians are disgruntled about the current workload, and also, the fact that their salaries are not sufficient in covering their economic and financial needs. Another complain that doctors have, is based on the fact that they often feel as if they are underappreciated and villainized by their patients and the Canadian government alike (Chen et.al, 2015).

(Weil, 2006: p. 347) argues that, Canadian physicians should be give an option to choose between an “opt-in status and opt-out status”. He mentioned that, this would not only give the physicians a sense of authority, but also encourage an active participation in the Canadian labour force. In agreement with this statement, (Chen et.al, 2015: p. 606) added that, “Opt-in physicians are entitled to bill the universal health insurance and are banned from receiving any private payments (i.e., out-of-pocket payments, or private insurance if permitted). In contrast, opt-out physicians are not allowed to bill the universal health insurance but can accept private payments”. However, emphasis must be placed on the fact that within the current health care system in Canada, several provinces voted against the “extra-billing” of private patients by opt-out physicians, that is charging patients more than the allotted amount is against federal law (Mayson et.al 2009). “The certification of doctors, nurses, therapists, and other health care workers has always involved a combination of provincial regulation and self- regulation by the practitioners themselves” (Miljan 2018, p.211). However, Miljan also mentions that, although the wages of most doctors are not set by the government, their incomes are however significantly influenced by the fact that provincial regulations determine the fees that doctors may charge the province for specific services, what services that will be paid for, whether they may charge patients more than the billable amount without penalty, and what the upper limit on their billings may be. (Mayson et.al, 2009) then argues that, this form of “informal” supervision allows doctors little to no room to exercise their authority and discretion, which then ‘forces’ them to find a more accommodating workforce.

However, despite the many compelling arguments in support of a privatization of the Canadian health-care system, many would argue that this would not be in the best interest of the majority population. (Angell, 2008: p. 916) argues that “there are strong moves within Canada to make the Canadian health care system more like the US system by partially privatizing it”. She explains that, those who are in favour of this privatized system generally make a comparison between the current health care system in Canada to that of the United States, arguing that it offers more choice and better quality treatment. However, this is only a misconception.

According to (Martin & Dhalla, 2018), not only will this have a negative effect on citizens within a lower socio- economic class, but will also affect “upper-class” citizens. According to an article published on The Globe and Mail website, a “two-tiered” or privatized health care system would mean higher tax incentives for those individuals who are considered upper class citizens. The article further went on to state that, this “new” system will also negatively affect businesses. The article mentioned that, because access to health care would then be based on wealth, large corporations would then be required to cover the medical expenses of their employers in an expedited manner. (Angell, 2008) added that, this would then lead to an inherent systematic bias as some employers would pay for their most favoured employees to “jump” to the front of the line. As a result, this additional cost for providing “too much” healthcare for employees would create an economic strain. (Martin & Dhalla, 2018) mentioned that, unlike Canada, Hospitals in the United Sates for example, operate on a pay for service basis, operating more from a business lens. She mentioned that, just like all business, their aim is to get more and not less “customers”. Services are offered to patients who can pay, and not based on a patient’s needs. Therefore, priority service is often given to those who can afford treatment, and not those individuals who are in dire need. In the United States for example, there are several reported incidents where patients were refused treatment at hospitals, simply because they were unable to cover the cost.

Unlike the United States, Canada has had a publicly- funded health care system for an extended period of time. Initially this system was heavily supported by Canadians, as it meant that the majority of medical treatments and hospital visits were almost entirely funded by the government. However, within the last decade, we have seen an increase in the number of Canadians who are advocating for a complete reformation or restructuring of the current health care system. (Lewis et.al, 2001) argues that, the majority of Canadians are concerned about the current state of the health care system and it sustainability, and are arguing that the state of the system is constantly depleting. “Also, an alarming eighty percent of Canadians feel that the health care system will need to undergo broad reform in order to meet the challenges of changing demographics” (Lewis et.al, 2001: p.926). However, this “reformation will increase the cost and demands on the part of the Canadian government. (Mayson et.al, 2009), added that one strategy that is being used by the government in an effort to limit discussions on the issue, is replacing the word privatization with other words such as “transformation”. However, this does not change the fact that the current system is in need of a complete overhaul.

In conclusion, there are several arguments in support of a health policy reform in Canada. These arguments suggest that, not only will a change be beneficial to the economy and the Canadian public, but this will also aid in the retention of Canadian doctors. Lengthy wait times and shortage of doctors are just a few of the many issues being encountered in the current system. This issues in not to implement new strategies in the public system, but is instead suggesting that citizens should be given a choice to choose between private and public healthcare. As argued in this research paper, contrary to popular belief, a lack of funding is not the main issues affecting the health care system. The issue is, both the doctors and patients are unhappy with the operation of the current system, and as a result are advocating for change. Therefore, based on the arguments presented, there is enough evidence to support the statement that Canada should privatize its healthcare system, as this will not only reduce patient wait times and allow beneficiaries with their own private insurance to pick their own doctors and services but it would also encourage Canadian doctors to practice within Canada instead of migrating to other countries.