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Ontario has highest private health care payments. And now more user fees?

Donald Drummond was recently part of a panel that made a (poorly received) report to  the Canadian Medical Association that recommended the expansion of user fees for Canadian health care (along with some other pro-privatization notions).  

This was notable as Drummond is leading a commission on public services in Ontario (which, conveniently, will report after the provincial election October 6).  

The panel report to the CMA comes as many private clinics are introducing ingenious user fees (e.g .$100 for a glass of orange juice-- I kid you not).  

User fees will enable those with the extra cash to monopolize more of the time and trouble of doctors and other other health care professionals, while the rest of us -- well we will just have to make do.  This is all the more irksome as the well to do tend to be less in need of health care services than the less well set. 

In any case, here are the words of the Director General of the World Health Organization introduction to a 2010 report (Health Systems Financing: The Path to Universal Coverage) that dealt with the scourge of user fees.

As indicated by the subtitle, the emphasis is firmly placed on moving towards universal coverage, a goal currently at the centre of debates about health service provision. The need for guidance in this area has become all the more pressing at a time characterized by both economic downturn and rising health-care costs, as populations age, chronic diseases increase, and new and more expensive treatments become available....Concerning the path to universal coverage, the report identifies continued reliance on direct payments, including user fees, as by far the greatest obstacle to progress.  (My emphasis -- Doug.) 

The report itself suggests it "is only when direct payments fall to 15–20% of total health expenditures that the incidence of financial catastrophe and impoverishment falls to negligible levels."

About 29.8% of Canadian health care expenditure comes from private (rather than public) payments. That's a lot of user fees (for those without private insurance).  And that's high for a developed country.   In fact it rates 18th out of 26 countries reported by CIHI (see chapter 7).

Other measures also bear this out.  Private health care payments account for 3.1% of the Canadian GDP, tied for the fourth highest percentage among the 26 developed countries reported by CIHI. And Canadians spends the third highest amount per capita on private health care payments ($1,216 in 2008).

No surprise, Ontario has higher private payments than any other province both as a percentage of total  health care expenditures (32.6% of total health care expenditures) and in total cash payments per capita  ($1,841 per person) (CIHI 2010 report, pages 32 and 33).  For total cash payments, that's 50% more than Canada as a whole.

So, expand user fees or other forms of private payments?  Quite the contrary.


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