Authors reveal Canada fares poorly compared to other nations and find ideas for reform in Sweden, Switzerland and the U.K. 

OTTAWA, November 22, 2013 – Most advanced nations share the goal of universal health coverage, but all use different policies to achieve this. Canada is near one end of the spectrum, with heavy government involvement in both the financing and the delivery of health care and limited private sector participation. At the other end of the spectrum, governments mostly regulate the private provision of health care services. A new MLI paper titled "A European flavour for medicare: Learning from experiments in Switzerland and Sweden" reveals that Canadians' cherished medical system is nowhere among the leaders in terms of health outcomes for the money spent.

While there is a tendency in Canada to compare our system with our southern neighbour, the United States, it is in Europe that we will find nations which achieve a better balance in health care delivery. This paper compares Canada's health care system with those of Sweden and Switzerland, two countries firmly in the middle of the spectrum of public/private involvement which rank high internationally in delivering results. It also includes a compelling example of how Britain's Labour Party sold the British people on much-needed reforms to that country's socialized medical system.

Lead author of "A European flavour for medicare," Mattias Lundback, a research fellow at the Ratio Institute in Stockholm, explains that Sweden is an example of a "Beveridge"-type health care system, where the emphasis is on hierarchical control. This model emphasizes specialized care, and often lacks adherence to individual demands. This problem is partly addressed in Switzerland's "Bismarck"-type of health care system, which provides insurance but not health care services per se to the population. While this gives an incentive to monitor overall health status, the system also produces incentives for too many health care procedures and interventions.

However, the most striking difference between Canada and these nations is the openness of European systems to new solutions. Starting in the 1990s, European nations like Sweden and Switzerland began to put the emphasis on what was in the patient's interest ahead of the interest of health care providers. Not all innovations proved successful, but overall the health care outcomes for both Sweden and Switzerland rank high and at a much lower cost than in Canada.

"After analysis and comparison, Sweden and Switzerland yield many examples of reform that have the potential to raise Canada's health care outcomes", concludes Lundback. Some recommendations would be permitted under the Canada Health Act:

  • Activity-based funding for surgical and hospital services
  • Private provision of hospital/surgical services, ideally combined with activity-based funding
  • Private parallel health care with dual practice
  • Independent insurance (social insurance)

Two additional recommendations, which have demonstrated successful outcomes in numerous other OECD countries, would either be disallowed or penalized by the Canada Health Act: cost sharing/user fees and individual tailoring of insurance policies.

While Canada has been slow to innovate, this does allow it to study and learn from other countries as it embarks on the inevitable overhaul of medicare as the population ages and costs skyrocket. As part of the Macdonald-Laurier Institute's series, Medicare's Midlife Crisis, this paper is another contribution to that learning process.

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The Macdonald-Laurier Institute is the only non-partisan, independent national public policy think tank in Ottawa focusing on the full range of issues that fall under the jurisdiction of the federal government.

For more information, please contact David Watson, managing editor and communications director, at 613-482-8327 x. 103 or email at On Twitter @MLInstitute

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