Private-Public health partnerships

If I ever get homesick for Canada, a five-minute conversation with a Canadian government official's usually an excellent cure. It always reminds me why I left.

On Friday, I met with a few visiting Canadians to give a bit of a state of play on policy. One of them asked about the Pharmac system. I noted it seems the best part of the overall health system, but that I can't imagine that a larger country could get away with it - and especially not a country right next door to the US.

But as part of the background, I'd noted that we have a fairly standard mixed private-public health system: a public health system combined with a private system that seems to work rather well. The public health system can contract in expertise and capacity when it needs it; having that available makes the public system better.

And I got to hear the ever-so-Canadian phrase two-tier. It's the phrase that Canadians use to give themselves an excuse for not thinking. Somehow, Canada got its national identity wrapped up in being not-American, and the public health system is a big part of that. Canada's version of a public health system is not like New Zealand's - there isn't a complementary private system in the same way. Anybody suggesting one gets accused basically of treason. Because any private provision would be two-tier, and result in outrage on the CBC and claims that the system was becoming Americanised, rather than just being like most other public health systems.

So stories like these would never happen in Canada. Instead, the queues would just get longer.

Capacity constraints see Canterbury DHB spend $143m on private surgeries

Thousands of hip, knee and other elective procedures have been outsourced to private providers in Canterbury over the past five years at a cost of about $143 million.

Canterbury District Health Board (CDHB) members say increased outsourcing has been necessary to meet demand, especially given post-earthquake capacity constraints.

"There's no point having a philosophical objection to using the private sector, because if we weren't able to access it thousands of people would have missed out on publicly-funded elective surgery," Andy Dickerson said.
...
CDHB member Aaron Keown said the health board had been closely monitoring the volume and cost of outsourcing. The CDHB could be penalised for not meeting Ministry elective surgery targets, he said, and people needed to realise bringing operations back in-house did not necessarily result in large savings.
...

The CDHB spent the most on outsourcing procedures to private providers including Canterbury Orthopaedic Services, which trades as Leinster Orthopaedic Centre, Southern Cross Hospitals and St George's Hospital.

NZ Private Surgical Hospitals Association president Richard Whitney said the private sector was already the dominant provider of elective surgeries in New Zealand,.

It could perform many procedures "for the same price that the public sector would be credited with" and would play an increasingly important role as demand for surgeries increased, driven by an ageing and growing population.

Private health insurance here remains cheap. We have a high-deductible plan basically as catastrophic coverage. I cannot be bothered saving receipts for reimbursement for any of the routine stuff - and why bother? We don't have car insurance to protect against the costs of an oil change.

The mixed system just works.

But boy did hearing the term two-tier in that Canadian accent bring back terrible memories of how stupid public policy debates are back in the Asylum. So glad to be out.