Reforms to reduce the fiscal burden of Canada’s public healthcare costs should preserve the core value of equal access while evolving away from universality, according to the author of the C.D. Howe Institute’s 2010 Benefactors Lecture.
In Critical Condition: A Historian’s Prognosis on Canada’s Aging Healthcare System, Michael Bliss, professor emeritus at the University of Toronto, reviews the history of Canada’s healthcare system and draws lessons for future reforms.
Bliss suggests the following:
• we reconcile ourselves to the fact of Canadians’ demand for a high and probably growing level of healthcare expenditure in a predominantly public system;
• consistent with our experience with other social programs once considered entitlements, we encourage the evolution of our health insurance system from providing universality of benefits onto a needs basis, preserving the core value of equal access;
• more attention should be paid to appropriate divisions of responsibility in the management of Canadian healthcare (enabling a more prominent role for medical researchers and practitioners in determining what is medically necessary); and
• hard questions be asked about the problems inherent in managing a complex “system” sheltered from market incentives, signals, and discipline.
Bliss argues that reimbursement for healthcare in Canada now be on the basis of financial need, not universality, following the path taken for previously universal benefits such as the Baby Bonus and Old Age Security, since reorganized according to a needs basis.
