Healthy Incentives: Canadian Health Reform in an International Context

Paul G. Thomas is a professor of political science at the University of
Manitoba, and the co-author of Canadian Public Administration:
Problematical Perspectives.

The Fraser Institute is known for its strong endorsement of market-based
solutions to public-policy problems. It is not surprising, then, to find
the main authors of this book arguing that health care is a
“high-tech” growth industry and that choking off health-care
spending is counterproductive. Instead of explicit or implicit rationing
of services, they propose that public-sector costs be reduced by
encouraging private spending on health care. More specifically, they
recommend the repeal of the Canada Health Act, favor a
purchaser–provider split in the delivery of health services, propose
“physician budget holding” (whereby physicians receive a block
budget for all patients on their rosters), and explore the option of
“medical premium accounts” paid into by citizens in anticipation of
the rising claims they will make on the health budget as they advance in
age. Whatever form of private participation is adopted, the authors
argue, it would be preferable to the complete termination of existing
services.

Included in the book are comparative studies on reform initiatives in
such countries as England, Germany, New Zealand, and Sweden. An exchange
between Conservative and Labour spokespersons from England reveals
interesting similarities in approach on how to reform Britain’s
National Health Service. Also addressed are reference pricing for
pharmaceuticals and the need to empower health consumers with respect to
choice of services. The latter notion is questionable, because its
implication that health is something we consume the way we do other
commercial products elevates individual choice in an economic
marketplace above collective choice in a political marketplace. Still,
the many valuable ideas in this volume constitute a substantial
contribution to the continuing dialogue on future directions for health
policy.