Businesses question competitiveness of health system

Survey shows Ontario businesses favour health care system with a mix of publicly and privately funded services

The auto industry has long cited Canada’s public health-care system and the money it saves them in employee benefits as the reason it chooses to build plants here rather than in the United States.

However, a new survey shows that more than half of Ontario businesses think a health-care system that offers both publicly and privately funded services would improve the province’s competitiveness.

In response to the recent Supreme Court of Canada ruling on private health insurance in Quebec, the Ontario Chamber of Commerce surveyed its 65,000 member businesses to get their opinions on health-care delivery in Ontario.

Of the 1,271 that responded, 65 per cent favoured a public-private blended health-care system. The chamber has made health care part of its public policy agenda.

“We want to have a discussion about this,” said Len Crispino, chamber president. “We’re not suggesting it has to be a two-tier system.”

He said that all the member businesses believe in fully accessible, universal health care but they also think that private-sector involvement could make the system, with its high costs and long waiting lists, better.

But the president of the Canadian Healthcare Association, which represents hospital and health organizations across the country, cautioned that more private involvement in Canada’s health-care system would hurt both employees and employers.

Based on the research the association has done, Sharon Sholzberg-Gray said that Canada’s publicly funded health-care system is a competitive advantage for businesses.

“It saves them the cost of paying for it,” she said. “If people are worried about payroll costs per employee, doubling the cost of health insurance for each employee does not seem to me to be a good option.”

She added that there is an important distinction between private funding and private delivery of health care. With private delivery, government funding can be distributed in a number of ways, including blood tests administered by private labs, which happens now.

But private funding means one of two things: either the user pays or individuals need private insurance and the only way that someone can afford private health insurance is to get it through group insurance, the cost of which inevitably falls to employers, said Sholzberg-Gray.

“In most countries, it’s really difficult for people to buy insurance on an individual basis,” she said. “It’s very expensive if you’re not part of the group.”

Gwyn Morgan, chief executive officer of Alberta-based oil company EnCana, is a proponent of opening up the health-care system to competition.

“I’m very supportive of the public health system,” he said. “But there’s no public health system in the world that’s worked effectively where there wasn’t choice.”

He said he’s not worried about paying for private health insurance for his Canada-based employees.

“If you choose to offer more for health care,” said Morgan, “I guess you don’t choose to offer as much for other benefits.”

Long wait times are a major problem in Canada, but Sholzberg-Gray said that every country has problems managing wait times and giving timely access to care. Instead of jumping to private insurance, as the Supreme Court ruling suggested in June, she said that Canada should solve these problems within the current system.

“There’s nothing inherently impossible about trying to resolve these kinds of issues in a publicly funded system,” said Sholzberg-Gray. “One of the issues is not so much money as a shortage of personnel.”

She said that as long as there’s a shortage of physicians, nurses, technicians and the like, there will always be problems with wait times, even if there is a parallel private option.

However, Morgan disagreed. He said offering a combination of basic health-care coverage for everyone and giving practitioners the ability to operate privately will actually improve the public system.

“What will happen is what has happened in Europe. You will end up with more people being freed up, more money being freed up for the public system because there’s not as much burden on it. The irony is that you end up with better public health care.”

He added that EnCana’s employees in developing countries, such as Ecuador and Oman, have better health-care coverage than they do in Canada because they have a private health-care option. Many of them find it a culture shock when they return home to higher taxes and a poorer health-care system.

“We actually had a case where an employee’s wife had a chronic condition that was reasonably serious and he just wouldn’t move back to Canada.”

Private health-care delivery is easier to implement than private funding but it too raises complex questions.

“Providing health services isn’t like manufacturing widgets,” said Sholzberg-Gray. “There can be unpredictable adverse events that cost a lot of money. That’s why it’s so hard to make money in complex health procedures and that’s why no one is suggesting private complex heart care clinics.”

Sholzberg-Gray said that some routine, simple procedures could be done easily and cheaply by the private sector.

“It’s not necessarily bad, but it’s not necessarily good because there’s no evidence yet that there’s financial savings.” She added that the public sector would end up paying for the high cost of unexpected complications, which could be up to $100,000 each.

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