Canada’s “single-pay” model doesn’t travel well In Canada, which has a single-payer form of UHS, all such coverage is administered and funded through taxes or premiums or both, but private insurance is prohibited from covering medical goods or services that are covered by the provincial plans. Although a handful of private clinics have fought to provide such options (Quebec and B.C., for example), they have been aggressively challenged in the courts on the premise that such competition might erode the public program. Most other universal systems eschew the single-payer model, preferring blends of public/private funding and administration. The U.K., for example, supplements its publicly funded National Health Service with a robust private health insurance system that allows an additional layer of optional services − private hospitals, shorter or no queues, enhanced personal care options for patients who choose to pay privately. And providers often work interchangeably in many areas. Germany, which initiated universal health care in 1883 (a system that has served as a model for many European countries) provides high-quality, comprehensive service through a system of more than 100 non-governmental private insurers known as sickness funds, with high earners, civil servants and self-employed persons able to opt out and buy private insurance. The government sets regulations and fees for the sickness funds, but plays no role in direct health delivery. Virtually no waiting lists, very high public satisfaction and a very limited bureaucracy. The equally highly rated Netherlands UHC is administered by private, competitive health insurers and health-care providers. Virtually all health insurance companies in the Netherlands are not-for-profit co-operatives that allocate any profits that they make to the reserves which they are required to maintain, or return them in the form of lower premiums. Among high-income developed countries, Canada’s single-payer model is a rarity in that it relies solely on annual global budgets or block grants. A block grant is, in reality, a “do the best with what you’ve got” ticket. It tends to generate access problems and waiting times, encourages fewer patient admissions, fewer costly treatment interventions, longer retention of lower-cost patients and early discharging of high-cost patients. The money doesn’t follow the patient. Conversely, virtually all other universal health-care countries have long since discarded block funding or global budgets in favour of activity-based funding which pays hospitals predetermined amounts of money for the care which they receive, largely following the Diagnosis Related Group (DRG) model developed in the U.S. in the 1980s which was designed to pay according to the specific services required for treatment of that patient. Writing in a June 2021 survey of international hospital payment patterns, Nadeem Ismael, senior fellow at the Fraser Institute concludes: “It is noteworthy that Canada’s provincial health-care systems are in a distinct minority in the developed world for not having adopted activity-based funding for hospital care in a meaningful way. Decades after reforms were undertaken in other developed nations with universal access health-care systems, and at a time when some nations are embracing even more sophisticated approaches to money following patients, no Canadian province has embraced a wholehearted shift to activity-based funding.” Ismael concludes: “Canada’s health-care systemprovides remarkably poor value for money to taxpayers and leaves patients with relatively poor access to medical services, despite its high price tag. Part of the reason for that poor performance is likely Canada’s commitment to an outdatedmethod of paying for universally accessible hospital care.” Health Canadian owned & operated 10 years law enforcement experience Scheduled home watch service Drone roof inspections Storm preparation assistance Concierge services Serving South and Southwest Florida Visit our site to schedule a virtual appointment patronpropertyser.com Or call Tim at (786) 707-8050 CSANews | FALL 2021 | 37
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