It's all about the benjamins (Canada $)

Shona’s stance is not one we encounter in public health very often. Essentially, she is advocating for a system that treats health services as commodities, patients as consumers. Shona’s viewpoint on entitlement stands in stark contrast with the viewpoint upon which the Canadian health care system is built: it is an egalitarian culture emphasizing positive freedoms. To Shona, entitlement to health care in this sense is ineffective and counter-productive; more effective would be the entitlement granted to a paying consumer. The solution that Shona proposes is to introduce competition, namely by incorporating private health insurance into the system. While this may very well raise the quality and efficiency of medical services in Canada, it is by no means Canada’s only option. In fact, it is not even the only option if competition is to be included as an essential component of the health care system.

Competitors vie to be recognized as the one best able to accomplish a given task. As such, competitors must be judged in how they perform. In a market-based system, consumers—or patients, in this case—do the judging, because providers are first accountable to their patients if they want to get paid—which often is the bottom line. Competition, however, can still exist and work effectively in a non-market system. Take, for example, Great Britain’s National Health Service. Within this system, providers are given bonuses for keeping their patients healthy. British providers, then, are not only accountable to their patients, but also a third party—the government—whose judgment determines how much the providers are to be paid.

Shona wants to introduce competition, to create a system in which health care providers have incentive to provide efficient care of high quality. Though adding private health insurance to the system may accomplish this task, it is only one potential solution. Canada has more than this one option if it seeks to reduce the number of stories like that of Shona. Canada may look to Great Britain to see how it has introduced financial incentive into the system without also introducing additional private financing.