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.


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

Unleashing the Campus Freedom Index Results

“Every man who says frankly and fully what he thinks is so far doing a public service. We should be grateful to him for attacking most unsparingly our most cherished opinions.” – John Stuart Mill, On Liberty

For centuries, our ancestors fought for free and democratic societies. Democracy, however, is a system that seems to be missing from most university in Canada, as reported in the Justice Centre for Constitutional Freedom’s (JCCF) Campus Freedom Index, 2014. The report, published by the non-profit legal organization based in Calgary, Alberta, aides parents and students in “choosing a school that will encourage, not stifle, their free expression rights on campus.”

University rankings, such as those based on teaching, classroom size, and research capacity, are common practice, however, measuring the state of free speech on university campuses is a novel endeavor. The author of the JCCF report acknowledges that it is the first of its kind in Canada, albeit it is the fourth edition. Between 2011 and 2014, the number of universities in the sample increased by nearly 200 per cent–from 18 to 52–which decreases the likelihood of bias and inconsistent measurement.

The Campus Freedom Index measurement relies primarily on two criteria: 1) university practices and policies and 2) student union practices and policies. Based on them, the author assigns five letter grades: A, B, C, D, and F. According to the report, “There are 24 campuses that earned at least one ‘F,’ assigned to the university or its student union.” Overall, the authored assigned only five ‘A’ grades to universities and student unions in the survey.


Nova Scotia has become a popular destination for Canadian and international students seeking a university education in recent years: in 2010, the province attracted 35,131 full-time university students–40 per cent of whom are international students. An increase in popularity, however, merits an increase in responsibility–a responsibility to preserve our free and democratic society.

The table below shows seven universities in Nova Scotia, the amount of funding they receive from the provincial government, and their rating according to the JCCF Campus Freedom Index, 2014. University of King’s College is the only university that received an ‘A’ grade, whereas the three largest universities in the province–Dalhousie University, Saint Mary’s University, and Cape Breton University–received an F grade.

Regarding the performance of student unions at universities in the province, the Acadia University Student Union received the sole ‘A’ grade for standing with its student newspaper The Athenaeum in defense of free speech, whereas the two largest student unions in Nova Scotia received an ‘F’ grade for their student union practices: Dalhousie University Student Union (DSU) and Saint Mary’s University Student Union. As a student at Dalhousie University, I felt shame when I saw the report. DSU has regressed from a ‘D’ grade in 2013 to an ‘F’ in 2014 due to their policies, whereas the university itself received an ‘F’ grade for the second year in a row.

One thing was very clear from the report: DSU has not amended their outdated policies, despite the student newspaper, The Dalhousie Gazette, covering the 2012 edition of the report and a former student of the university conceding the absence of freedom of speech on campus in an interview with The Prince Arthur Herald. It is time to update the outdated policies, embrace those that accommodate free speech, and discard those that reflect a negative image of campus.

Last winter, the DSU president violated the union’s constitution, the very constitution he must uphold as the leader. How could DSU expect students to follow their policies when the leader ignores them? Moreover, although some critics argue about the credibility of the JCCF, it is the methodology underpinning the report that is most important. The authors use a very simple and straightforward method to evaluate campus freedom and there is an important message within: universities and student unions in Nova Scotia, and throughout the country, must take the freedom of speech seriously and should strive for better results in the 2015 report.

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

AIMS on Campus Announces the 2014-15 Student Fellows

Following a tremendously successful year in 2013-14, AIMS on Campus is happy to announce the 2014-15 student fellows:

Rinzin Ngodup
Dalhousie University, Development Economics

Rinzin is a graduate student in development economics at Dalhousie University. Born to Tibetan parents in India, he completed undergraduate studies in economics at the University of Madras, India. He has worked as a teaching assistant at Dalhousie University and has been living in Halifax since 2010 with his cousin. In his spare time, he enjoys reading classic novels and practicing meditation.

Interests: development economics, welfare economics, environmental economics, and macroeconomic policy

Samuel Hammond
Carleton University, Economics

Samuel is a Nova Scotia-native, born and raised on the South Shore. During his undergraduate studies at Saint Mary’s University, he was Editor-in-Chief of the SMU Journal and spent over a year working as a junior economist for ACOA Halifax. He currently resides in Ottawa, where he is a graduate student in economics at Carleton University.

Interests: social choice theory, regional economic development, public finance, and growth theory

Leo Plumer
McGill University, Economics and Political Science

A Newfoundlander, Leo resides in Montreal, where he is enrolled in the joint economics and political science undergraduate programme at McGill University. He is an active member of Students for Liberty, a writer for the Mises Canada Emerging Scholars blog, and a proprietor of his own campus group, all of which has contributed to his interest in public policy. During the few breaks he takes from complaining about politics, he is an avid outdoorsman, gourmand, and metal-head.

Interests: development economics, welfare economics, social justice, international relations, and monetary policy

Corey Schruder
Cape Breton University, History

Corey is pursuing an undergraduate degree in history at Cape Breton University following two years at Queen’s University. He was previously an executive member of the Queen’s Students for Liberty group, where he was responsible for organizing the “Free Speech Wall” on campus, a contributor to the Queen’s Journal and Queen’s International Observer, and a former research assistant with the Canadian Taxpayers Federation. Most recently, he was an intern at the PMO. In his spare time, he enjoys reading about economic history and spending time with friends and family.

Interests: economic history, labour policy, municipal governance, welfare economics

We’re excited to begin another year and hope to expand the success brought by last year’s student fellows!