Professor of Paediatrics, Obstetrics & Gynecology, and Public Health, University of Toronto; Director, Maternal-Infant Care (MiCare) Research Centre, Mount Sinai Hospital, Toronto, ON.
Professor, Department of Emergency Medicine and School of Public Health, University of Alberta, Edmonton, AB.
Healthc Policy. 2021 Feb;16(3):30-42. doi: 10.12927/hcpol.2021.26435.
Medicare is a publicly funded healthcare system that is a source of national pride in Canada; however, Canadians are increasingly concerned about its performance and sustainability. One proposed solution is private financing (including both private for-profit insurance and private out-of-pocket financing) that would fundamentally change medicare. We investigate international experiences to determine if associations exist between the degree of private spending and two of the core values of medicare - universality and accessibility - as well as the values of equity and quality. We further investigate the impact of private spending on overall health system performance, health outcomes and health expenditure growth rates. Private financing (both private for-profit insurance and private out-of-pocket financing) was found to negatively affect universality, equity, accessibility and quality of care. Increased private financing was not associated with improved health outcomes, nor did it reduce health expenditure growth. Therefore, increased private financing is not the panacea proposed for improving quality or sustainability. The debate over the future of medicare should not be rooted in the source of its funding but rather in the values Canadians deem essential for their healthcare system.
加拿大的医疗保险是一项公共资助的医疗体系，是国家的骄傲；然而，加拿大人越来越担心它的绩效和可持续性。有人提议通过私人融资（包括私人盈利性保险和私人自付费用融资）来解决这个问题，这将从根本上改变医疗保险。我们调查了国际经验，以确定私人支出程度与医疗保险的两个核心价值观——普遍性和可及性，以及公平和质量价值观之间是否存在关联。我们进一步研究了私人支出对整个卫生系统绩效、健康结果和卫生支出增长率的影响。我们发现，私人融资（包括私人盈利性保险和私人自付费用融资）会对普遍性、公平性、可及性和医疗质量产生负面影响。增加私人融资与改善健康结果无关，也不能降低卫生支出增长率。因此，增加私人融资并不是改善质量或可持续性所提议的万灵药。关于医疗保险未来的争论不应该基于其资金来源，而应该基于加拿大人认为对其医疗体系至关重要的价值观。
