AIMS releases two papers showing better ways to get more money for health care

[HALIFAX] —   Empowerment and accountability – these are the touchstones of AIMS’ latest health policy background reports released today. These two reports are the latest releases in a series of papers that informed the Institute’s major contribution to the country’s debate over the future of medicare, the Definitely NOT the Romanow Report, which received front-page coverage in the national media on its release last week.

The first of the two background papers released today, Medicare and User Fees: Unsafe at any Price?, seeks to provide a second opinion about the practicality and implications of introducing some form of cost sharing to the Canadian health care system.

“From Dublin to Stockholm to Zurich, we find that countries with public health care systems (often not all that different from our own) use some type of patient cost sharing, “ says Dr. David Gratzer, co-author with Carl Irvine of Unsafe at any Price. “ Numerous studies, including one of the largest social science experiments in history, suggest that user fees do change patient behaviour. These studies also suggest that, if properly employed, user fees have no impact on health outcomes. User fees, thus, are safe and effective.”

Unsafe at any Price does not suggest that user fees are a panacea for Canadian health care. The problems facing medicare are numerous and complex. That being said, governments have been increasingly willing to experiment with new initiatives over the past decade. The time has come for a serious look at user fees.

This opinion is supported by the work contained in the second background paper released today, Improving Canadian Health Care: Better Ways to Finance Medicare. “It seems everyone agrees that health spending will continue to grow and that more money must be brought into the system,” says Brett Skinner, author of Better Ways. “The debate has to focus on the best way to introduce this money to the system. By combining a flat deductible and an MSA (medical savings account) targeted at low income individuals for example you can cut medicare costs, improve accountability, build in market incentives for service improvements and give people more power in the health care system.”

As with all other forms of insurance, a health care deductible would set the maximum amount that individuals would pay towards their own care. A MSA is a tool that allows people to build, tax free (like an RRSP), a pool of money for future health care needs. Skinner’s paper looked at the health care usage of Nova Scotians over the last ten years and determined that combining a flat deductible of $325 and a government-financed MSA targeted at individuals who make less than $32,000 would save medicare $88.3 million in Nova Scotia alone and reduce overall demands on the system by about 5 percent, while ensuring the people on low-incomes faced no financial obstacles to obtaining needed medical care.

In the first draft of Improving Canadian Health Care the savings had been estimated at $60.3 million and this figure was included in the first electronic version of AIMS Definitely NOT the Romanow Report, a comprehensive alternative to the tax and spend suggestions of Roy Romanow, the federal commissioner on the future of health care. Final review of the data found that Skinner had under-estimated both the savings for medicare and the benefits for the system as a whole through overall reductions in spending and reduced waiting times. These significantly greater savings have now been incorporated in the final version of Definitely NOT the Romanow Report, available on line.


For further information, contact:
Brian Lee Crowley, President, AIMS, 902-499-1998
David Gratzer, (416) 544-8920
Carl Irvine, (416) 413-1879
Brett Skinner, 519-978-9936