British Columbia

Should Canada have a hybrid public-private health care system?

Victor Rodwin, professor of health policy and management at New York University, says countries with a hybrid public-private health care system have shorter wait times and better access to care but have strong regulatory systems.

A hybrid system could shorten patient wait times but needs strong regulation, NYU professor says

NYU Professor Victor Rodwin says hybrid public-private healthcare systems can work but only if properly implemented. (Jessica Doria-Brown/CBC)

A constitutional challenge to B.C.'s ban on private health insurance is underway, reigniting a debate on whether Canada's publicly funded health care system should be open to some privatization.

Victor Rodwin, a professor of health policy and management at New York University, has studied different health care systems across the world.

He told CBC's The Early Edition that a hybrid public-private health care system, like the one in Germany, could reduce patient wait times — but only if properly implemented.

"There's no perception of great wait times comparable to what you find in Canada. If you have a little bit more money in Germany ... you can see doctors who extra-bill. There's no perceived problem of rationing ... because if there's no room in the public sector, you go to the private sector."

The German system, Rodwin described, includes private supplementary insurance as well as private non-profit and for-profit hospitals. Private doctors can work in public hospitals, and beneficiaries with their own private insurance can pick their own doctor and services.

Needs strong regulatory oversight

But before Canada starts opening the doors to privatization, Rodwin said it better be prepared to implement strong regulatory measures.

The German system only succeeds because of strong regulatory oversight, he added.

"It requires a long institutional infrastructure that's been built up to enforce that kind of system ... You don't just change systems overnight," he said, adding "even if these systems operate well, it doesn't necessarily mean they will operate well in Canada."  

Rodwin also cautioned that while Germany may have shorter wait times, it could be due to factors other than private billing .

For example, he said, Canada might have longer wait times because it has fewer beds and doctors per capita than Germany. 

And there could be other solutions to solving long wait times like implementing different appointment procedures and telemedicine.

Greater inequity a possibility

Although it is nowhere as bad as the United States, Rodwin said, there are greater inequalities in access to care in Germany's public-private hybrid system compared to Canada.

If Canada wants to protect this status as having one of the most equitable health care systems in the world, he said, it won't be easy.

"In principle, there's nothing wrong with [allowing private health care] as long as the system is properly regulated. If you simply unlock the system and let doctors extra-bill, you have a risk of creating far greater inequality in a system which is known throughout the world as meeting the ideals of an equitable health care system."

With files from The Early Edition

To listen to the interview, click on the link labelled Professor Victor Rodwin on the benefits of a hybrid health care system