Globe and Mail national columnist and author speaks with MLI about what's ailing Canada's health care system

OTTAWA, January 23, 2014 – In the latest instalment of the Macdonald-Laurier Institute's Straight Talk series of Q&As, Globe and Mail national columnist Jeffrey Simpson explains that the problem with Canada's health care system is that it's quite clear we aren't getting value for money. Not only that, the provinces are going to have to make do with less health care funding in the future while attempting to improve outcomes.

On the question of whether Canada has the best health care system in the world, Simpson says "I think that perspective now lies pretty much in tatters". But there is reason to be optimistic. "We can now have a frank conversation and that's very, very helpful. … I've heard ministers of health say that we don't have the best health care system in the world, that we have an underperforming system. I tell you, five to 10 years ago they were scared to say that publicly because they thought they'd be hung from a lamppost".

Simpson, who is the author of a prize-winning book on Canadian health care titled Chronic Condition, feels that reductions in federal transfers and provincial health budgets "will actually produce more change and more reform than when you were pouring 7 percent more into the program [each year]."

Recommendations for reform stemming from the interview include:

  • Adopt a single, federal drug formulary to reduce pharmaceutical costs.
  • Constrain growth in the salaries of health professionals.
  • Invest more in community care rather than hospitals.
  • Allow more private delivery of care, for example doing repetitive procedures which should be done outside of hospital where possible.

On the question of user fees or co-payment for health care, Simpson says that while he understands the appeal and that they are accepted in other jurisdictions, user fees are not right for Canada. Imposing them "presumes that there's a fair bit of moral hazard in the system, that is to say, frivolous use of a free good". But he doesn't see that much moral hazard, and believes it wouldn't be worth the "administrative hassle" to impose user fees.

On the Chaoulli Supreme Court decision in 2005, Simpson says "I thought, and so did many other people who came out and made comments after that, that would kind of open the door to more private insurance", but that never materialized. "It's been very interesting that no provincial government and no group of physicians has chosen to go through this open door," says Simpson. In any case, he doesn't think "it's a legal question at all. I think it's a political question", he says.

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