2. Private health care for medically necessary treatment; dual practice for physicians to maximize the volume of services provided to patients in both public and private settings.
A private parallel health care sector plays several important roles: first, it provides individuals an option to return to normal life more rapidly than might be possible through the universal system. Second, when patients use the private sector they free up resources in the universal system for patients who have opted not to seek private care. Third, a private parallel health care sector provides a safety valve for the public system in the event of a capacity limitation or sudden increase in demand.
"In addition, a private parallel health care sector creates incentives for better service in the public system through competition," Esmail said."
Sweden also allows physicians to work in both the public and private health care sectors rather than requiring them to opt out of the universal system. This has the benefit of making more efficient use of highly skilled medical resources.
"Dual practice for physicians is common in developed countries including Denmark, England, Ireland, New Zealand, Norway, Spain, Sweden, Australia, Finland, and Italy," Esmail said.
3. Cost-sharing regimes for universal health care with reasonable annual limits and automated exemptions for low-income populations.
Cost-sharing encourages patients to be more careful about when and where to seek health care, thus increasing the cost efficiency of the system (ultimately reducing total spending) and improving access to treatment for those in need. A lack of cost-sharing (i.e. when patients are required to pay for a portion of their insured medical services) has resulted in excessive demand and wasted resources in Canada's health care system. Cost-sharing policies have been shown not to have an adverse effect on health outcomes as long as low-income populations are exempt.
4. Consider a blended funding approach for primary care with a large fee-for-service component.
Sweden's reliance on salary payments for physicians will not work in Canada due to Canada's independent practitioner model and doctor shortage. However, Sweden's use of a blended payment model for primary care services, including both capitation and fee-for-service, may be worth further examination.
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The Fraser Institute is an independent Canadian public policy research and educational organization with offices in Vancouver, Calgary, Toronto, and Montreal and ties to a global network of 86 think-tanks. Its mission is to measure, study, and communicate the impact of competitive markets and government intervention on the welfare of individuals. To protect the Institute's independence, it does not accept grants from governments or contracts for research. Visit www.fraserinstitute.org.
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