FREEDOM TO CHOOSE

Prairie Centre Policy Institute Weekly Commentary
WHERE DO WE GO FROM HERE - March 15, 2004
Why not “Europeanize” healthcare?
Brian Lee Crowley and Johan Hjertqvist

Citizens of the European Union have considerably more health care rights than Canadians.

Europeans are now entitled to seek medical care anywhere within the EU, including from the state health care systems in other countries, and to have it paid for by their home country. Governments don't decide whether the care elsewhere is superior. The patient decides. If the patient judges that services available in another EU country are better than at home, the home country authorities must pay for it. They cannot even insist on the patient applying in advance to be treated in another country.

In the most recent example of this growing trend, the courts recently ordered the Swedish Social Insurance Office to pay for rheumatoid patient Susanne Jelinek's treatment in Germany. That decision merely confirms a growing body of case law which has been evolving in the past few years.

By opening up a European health care market where patients may travel and use the health care services they deem necessary without the permission or interference of their national health care authorities, the EU has laid the groundwork for a consumer-driven revolution in health care. One of the EU's key jobs has always been the removal of all the obstacles to the free movement of people as well as goods, services and capital. Now Europeans suffering from medical ailments have that freedom too.

How different from Canada. Here provincial bureaucrats decide if a treatment available in another province is something they will pay for, and if so, how much they will reimburse. They decide if the waiting times for various procedures are too long, and therefore whether to give permission to get those procedures elsewhere. And if you travel outside the country, and your private health insurance isn't paid up, heaven help you.

Sometimes governments in Canada use their freedom to buy health care services in other jurisdictions. The government of Ontario, for example, bought cancer care services for Ontarians in New York state when the queues at home got to be politically intolerable. But give patients the freedom to choose for themselves? Out of the question.

Unlike European courts, Canadian courts have been of little help to health care consumers. They have ruled that Canadians have no right to the health care services that their provincial governments supposedly "insure" on their behalf. They have to take whatever the provincial authorities want to provide. If a private health insurer took premiums promising to provide a defined list of health services and then failed to do so, the courts and public regulators would be on them like a ton of bricks. Because it's medicare, from the courts' point of view, it's hands off. The Canada Health Act gives you a right to comprehensive health care that's portable? Good luck getting a judge to agree with you. If the Chaoulli case now heading to the Supreme Court is successful, it may establish the right to seek private care, but not mobility within medicare.

Now that EU law is starting to bite, the rights of European patients will be increasingly defined by law, not administrative discretion. In Canada we still have provincial public-sector monopolies in charge of health care. They live within their budgets by restricting access to care through queuing and other forms of rationing because they do not bear the costs of the pain and suffering of their patients who have to wait too long for treatment. But give people the power to seek medical care anywhere in Canada and make the home province pay for it and suddenly the power relationship is reversed. Provinces will have every incentive to make needed care available locally and to do so out of improved productivity, not tax increases.

As mobility within the EU increases, the quality and cost of care will become subjects of European-wide comparison. Consumers will be better able to call care providers to account. Ranking, rating and market information will give consumers added clout. Think how it might transform Canadian medicare if a patient in Saskatoon had a right to drive to Edmonton to get their hip replacement and the Saskatchewan government had to pay, or if a sick child in Amherst, N.S., could pop in to Moncton to see a specialist and have Nova Scotia pick up the tab. And surely that is what it means to have a health care system that is portable and comprehensive.

The European medical care market is starting to open up. Once it is fully opened, the possibilities will be enormous. The Canadian health care system remains firmly closed, a bureaucrat's dream and a patient's plight. If Canadian health care consumers, who are asking for ever more authority over their health and their lives, are to succeed in getting it, Europe is showing the way.

Brian Lee Crowley is the president of the Atlantic Institute for Market Studies in Halifax (www.aims.ca); Johan Hjertqvist is the director of the Health Consumer Policy Centre of Timbro in Stockholm, Sweden.

“Where Do We Go From Here” is a feature service of the Prairie Centre Policy Institute.