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'Follow Sweden' on health care: Did the Fraser Institute finally get it right?

| May 23, 2013
Photo: Mando Gomez/flickr

If you are familiar with the work of the far right-leaning Fraser Institute, you'll hardly be surprised when I write that their latest piece of "research" is full of deceit.

The Fraser Institute claims to examine the Swedish health-care system and in the end concludes that Canada should scrap the Canada Health Act and privatize, privatize, privatize -- no surprise. In a particularly fascinating move, the Fraser Institute compares financial expenditures in both health-care systems and promotes the most expensive methods as a cost-saving measure in Canada -- huh?

So let's start with the basics. In Canada, the two most significant cost drivers in the health-care system are physicians and pharmaceuticals. Physicians are expensive here because most of our physicians are on fee-for-service. Sweden is able to save money because their physicians are salaried and their nurses work more to their full scope. This means nurses can do more of the work they've been trained to do and my doctor does not get a service payment for checking off a box when I need routine blood work done (for example).

Salary for physicians is not new in Canada. Several places, including Community Health Centres, have doctors on salary and it works quite well. It's something medicare allies have been promoting for a long time.

The Fraser Institute mentions that Swedish physicians are salaried, but they do not recommend that Canada does the same. Instead, they recommend a large fee-for-service component into a blended funding formula. So one of the biggest cost-saving measures between Sweden and Canada is eliminated immediately.

The other area of spending that competes with physicians for the number 1 spot (and often surpasses them) is in pharmaceuticals. Sweden has a universal pharmacare program. It does include co-pays of up to $200 or so a year. But pharmaceuticals are mostly covered by taxes.

Canada on the other hand, pays the second-highest price in the developed world for medicines. Proposed trade deals with Europe and the Transatlantic will increase those costs even more. So, recommending that Canada adopt a national pharmaceutical plan that will lower drug costs seems reasonable. But that's not what the Fraser Institute recommends. In fact, they almost skip over that major detail entirely!

The same goes for dental care. Sweden has a universal dental care program. The Fraser institute lists major differences between the health models of Canada and Sweden but they do not list dental care or pharmacare as one of these.

The report ignores long-term care which is mostly publicly financed but increasingly privately provided. Perhaps the Fraser Institute did this because of the bad press private facilities in Sweden have received, notably the rule to weigh patients diapers before changing them to ensure they're at "full capacity". For-profit facilities need create profit for their investors. They will do it at any and all costs.

Sweden has been criticized several times for inequitable access to health care, particularly for those in more rural or remote areas. Private health care is driven by profits, not rights, and therefore private facilities do not operate in areas that they cannot make a profit. City Councils --the body in charge of community health services in Sweden -- have been unable to persuade private facilities to operate in more remote areas. This leaves large gaps in accessibility for many people.

Let's not forget about Sweden's generous social services and focus on preventative health. There's more to health care then just hospitals and health professionals, there are the social determinants of health. Low poverty levels and accessible and broad social services mean healthier citizens who may need less care. The reality in Canada is unfortunately very different and until we seriously address our social determinants of health, we can't compare ourselves to a country that has largely done this. Assuming that our populations' needs will be similar to Sweden's is just poor research.

Most of the Fraser Institute's suggestions have already been tried in Canada. A parallel public-private health-care system where doctors can work in both systems proved to increase wait times for everyone in Quebec. Doctors artificially lengthening the wait times of their public patients so that they could treat them in their private practices (see: (see: Duplicate Private Health Care Insurance: Potential Implications for Quebec and Canada. Odette Madore. Economics Division, Parliament of Canada. 20 March 2006). Alberta's flagship private hospital, the Health Resource Centre went bankrupt a few years ago leaving patients in limbo and taxpayers holding large bills to keep the lights on.

The Swedish system allows for queue jumping. Although the Fraser Institute does not term it this way, they seem satisfies that Swedes can pay for private health insurance that gets them to the front of the line. This insurance is expensive, so only the wealthiest would benefit. Poll after poll in Canada has shown that we don't share this value with Sweden. In Canada, your quality and right to life is not dependent on your ability to pay.

The Fraser institute is not recommending a fully private health-care system. Instead they're suggesting that we have a parallel public-private system. This allows for-profit health care to cherry pick the healthiest and wealthiest patients. A public system is needed for the other 99 per cent of us and the chronically ill. What this means is that the public system needs to exist to grow the private sector's profits.

The report ends by suggesting that Canada scrap the Canada Health Act because it impedes on private interest to make a profit off us and our patients. Sweden's health-care system has lots going for it, the good stuff is just largely absent from this report.

Photo: Mando Gomez/flickr

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