Private Hospitals and Two-tier Healthcare

I argued previously that private hospitals could play an important role in reducing hospital wait times and may result in greater efficiencies in the Canadian healthcare system. Yet, skepticism toward private-sector involvement is rife in Canada and many folks believe that it could create a more inequitable healthcare system. In fact, one pundit argues that provincial governments need to further consolidate their control over healthcare.

The widespread negative perception of “private healthcare” in the United States reinforces the skepticism that most Canadians have toward private-sector inolvement, which is the subject of health economist Audrey Laporte’s new study, “How Markets Can Put Patients First: Economics Before Politics in Canadian Healthcare Delivery.” This study argues that “Historically, the tendency among Canadian health policy analysts and policymakers has been to compare Medicare with the American system and to conclude that since we are doing much better than Americans in so many of the standard metrics used to judge healthcare systems, notably cost and various measures of access to care, we don’t need to consider making any significant changes to the structure of Medicare.” Nevertheless, comparing Canada’s healthcare system to that of the United States is a fallacy of composition, which is when someone has a distorted belief that what is true in one instance is true in all instances.

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In the last decade, Canadian health expenditures have skyrocketed and one estimate shows that “total public health spending has grown at an average annual rate of 7.5 per cent.” Excluding federal transfers, roughly 88 per cent of Nova Scotia’s provincial revenues pay for healthcare services on an annual basis. Yet, despite these enormous outlays, Nova Scotia ranks last in hospital wait times.

One of the problems facing the Canadian healthcare system is that provincial governments determine the price of healthcare services behind the scenes and patients (who double as taxpayers) remain uninformed. Essentially, the monopolistic structure of Canada’s healthcare system results in limited choices for Canadians seeking medical care and the result is longer wait times and poorer outcomes. In fact, there has been a surge of Canadians who are seeking medical treatment abroad, which indicates that there is room for improvement. An alternative system that provided more options to individuals seeking healthcare would be a huge improvement.

According to the Health Council of Canada’s 2007 survey, 47 per cent of the sample population like the idea of having private hospitals in Canada and 67 per cent felt that the Chaoulli decision was the key to two-tier healthcare. Indeed, the coexistence of publicly- and privately-operated hospitals will create efficiencies by reducing wait times as has happened in other developed countries. These countries, such as the Netherlands, Switzerland, and France, boast healthcare systems similar to that of Canada’s, but with a few subtle improvements–including two-tier healthcare. In the Netherlands, for instance, there were 151 hospitals and 52 outpatient clinic owned by 93 private organizations in 2010 and Dutch citizens reported much better outcomes than Canadian citizens: 41 per cent of Canadians reported waiting longer than four months for a surgery compared with 5 per cent in the Netherlands.

Given the inefficiencies plaguing Canada’s healthcare system, the time is ripe to change the status quo such that all Canadians receive quality medical treatment in a timely manner. One small step toward achieving this objective would be to allow private health insurance, which would ensure that all Canadian citizens have equitable access to healthcare.

Rinzin Ngodup is an AIMS on Campus Student Fellow who is pursuing a graduate degree in economics at Dalhousie University. The views expressed are the opinion of the author and not necessarily that of the Atlantic Institute for Market Studies

Tourism, Education, and Exports: Nova Scotia in the Context of Cheaper Energy and a Weaker Dollar

In recent months, oil prices have fallen dramatically and the Canadian dollar has weakened, which has led to speculation that Canada’s economy could be on the verge of an economic crisis. Yet, despite the obvious drawbacks of these developments, they could yield serious economic benefits for Nova Scotia, particularly for firms that export their goods and services to other jurisdictions. On the contrary, however, the cost of imports could rise and harm those consumers who rely on imported goods and services.

Nova Scotia’s economy relies heavily on education, exporting goods and services, and tourism, all three of which could benefit from lower energy prices and a weaker dollar. In fact, these two developments could help the province achieve the recommendations featured in the OneNS report, i.e. doubling the revenue from tourism in the next ten years, expanding the province’s export industry to meet the demand of the global economy, and developing a strategy that would help retain international students in Nova Scotia after they graduate.

Most projections anticipate that the Canadian dollar will remain relatively weakened in the coming months, which could bring enormous benefits to the province’s tourism industry and the estimated 24,000 individuals working in it–one person for every twenty living in communities across the province. In Nova Scotia, 1.9 million tourists traversed the province in 2014 and hotels sold 250,800 rooms, which generated $285 million in economic activity. There are also spillover benefits that help indirectly stimulate the local economy. Essentially, as the Canadian dollar weakens relative to other currencies and exchange rates fall, visiting Canada will become more attractive to foreigners and those who have already planned their vacations will have additional money to spend.

A weaker Canadian dollar might also encourage international students to pursue an education in Canada and postsecondary institutions in Nova Scotia could be among the primary beneficiaries. Furthermore, it would also make housing more affordable for international students who benefit from a lower exchange rate, which could dissuade students from choosing schools in Europe or the United States. Lastly, an influx of international students would increase the demand for local goods and services, resulting in additional economic activity and generating more revenue for local and provincial governments.

In his keynote speech at the Institute’s “For the Love of Nova Scotia, Let’s Focus on the Economy” event on February 11th in Halifax, Oxford Frozen Foods President John Bragg argued that Nova Scotia’s export industry should expand to the global market. Fortunately, these exporters will benefit from lower energy costs and a weaker currency and the time is ripe for those firms to expand their marketing efforts to countries in Asia and Europe wherein demand for the goods and services that Canadian firms offer is high. In fact, Clearwater Seafood Incorporated reported $444.7 million in earnings in the 2014 fiscal year and international sales have been rising in recent months. As Roger Taylor put it in the Chronicle Herald, “Product has a lot to do with it, but Clearwater is proving that being based in Nova Scotia is no impediment to successfully doing business around the world.”

To clarify, falling oil prices and a weakening currency has some clearly negative effects, particularly for Canadian firms in the western region. In Nova Scotia, however, those two developments could bring tremendous economic benefits to the province by encouraging tourism in the region, enticing international students into attending one of Nova Scotia’s premier postsecondary institutions, and making Canadian exports more affordable to international consumers.

Rinzin Ngodup is an AIMS on Campus Student Fellow who is pursuing a graduate degree in economics at Dalhousie University. The views expressed are the opinion of the author and not necessarily that of the Atlantic Institute for Market Studies

Uneconomic Healthcare: Rising Costs, Longer Wait Times, and the Argument for Private Sector Involvement

Many countries have experienced rising healthcare costs in recent decades and this phenomenon has stimulated a lively debate about the policy options available to governments for mitigating those costs. In Canada, per capita public healthcare expenditures will be roughly $6,057 in 2014–reflecting a staggering total of $215 billion that year.

An important feature of the Canada Health Act, enacted in 1984, is access to healthcare, i.e. ensuring that all Canadians have equal access to public healthcare in every province. Accessibility is a contentious issue, however, and some folks argue that prohibiting Canadians from purchasing private health insurance interferes with their constitutional right to equal access in Canada. (As a result, there have been several lawsuits addressing the issue of private health insurance and many individuals seek treatment abroad.)

In 2014, the Fraser Institute released a study, titled “Waiting your Turn: Wait Times for Health Care in Canada,” that reveals the median waiting time for medically-necessary treatments in Canada to be 18.2 weeks, which is significantly higher than other OECD countries. Echoing this assessment of Canada’s public healthcare system, the Common Wealth Fund (CWF) published a report recently that ranks Canada last in terms of “timely access to healthcare.” Nova Scotia’s average wait time is 32.7 weeks, which is considerably higher than in other provinces. (In Ontario, for instance, the average wait time is 14.1 weeks.) Health Minister Leo Glavine recently admitted that Nova Scotians wait too long for basic medical procedures, and although he touched upon the impact of unions in the province, the provincial government is primarily responsible for healthcare outcomes in Nova Scotia.

The distributional variation in Canadian wait times is staggering, particularly in the Maritime provinces, which have the longest wait times in the country. As previously mentioned, one could argue that unusually long wait times for medical procedures represents a constitutional violation, and from the economic perspective, a healthy workforce should result in greater efficiencies, less absenteeism, and higher productivity levels. Furthermore, in “The Human Capital Model of the Demand for Health,” economist Michael Grossman argues that “health can be viewed as a durable capital stock that produces an output of healthy time.” Because health depreciates as one ages, he also argues that people increase their healthcare expenditures as they age to maintain the same output of “healthy time.”

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Nova Scotia’s population is also ageing considerably faster than the national average and this phenomenon requires larger investments into healthcare infrastructure. In the 2013, for instance, Nova Scotia’s government allocated $3.9 billion or $ 4124 per capita expenditure for healthcare services. Although healthcare expenditures have been rising in all provinces, Atlantic Canada’s ageing population and relatively poor economic performance will create serious fiscal challenges in coming years. Specifically, as the population ages, the demand for medical treatments will rise and eventually exceed the supply, resulting in longer wait times and rising healthcare costs. (Because the provincial government retains a monopoly on most, if not all, medical procedures, public healthcare spending will rise out of necessity.)

Eliminating restrictions that prevent individuals from accessing private healthcare, which would theoretically reduce the burden shouldered by the public healthcare system, is one option available to the provincial government in Nova Scotia. More broadly, implementing measures that facilitate private sector involvement in the province’s healthcare sector would serve to reduce wait times, increase accessibility, and improve healthcare outcomes for all residents in the province. However, in my future blog, I can discuss more about the importance of private sector involvement and its positive impacts on reducing waiting time.

Rinzin Ngodup is an AIMS on Campus Student Fellow who is pursuing a graduate degree in economics at Dalhousie University. The views expressed are the opinion of the author and not necessarily that of the Atlantic Institute for Market Studies