Canada Should Consider Healthcare the Swiss Way

Tired of waiting for health care? Here's what Quebec can learn from Switzerland.

Since its creation, the Montreal Economic Institute (MEI) has published numerous studies on the workings of the Canadian health care system and proposed possible reforms by taking inspiration from the experience of other countries.

After Sweden, France and Germany, the MEI recently looked at the case of Switzerland and went to see how health care is delivered in hospitals in this country of eight million inhabitants.

In Switzerland, the way the health care system is organized has evolved in the opposite direction of Canada's, where the trend has rather been toward ever more centralized regulation and public financing.

Since 1994, the Swiss can freely choose their health insurance provider — in addition to their health care establishments and their doctors. This favours a high level of competition between the 90 private insurers — all non-profits — in terms of prices and service quality.

There is no federal health department. Each canton takes care of the organization of care within its territory independently and makes sure that all of its inhabitants have basic medical coverage. In 2010, around a third of the country's citizens received financial assistance from the government to reduce their insurance premiums.

The private sector occupies an important place in the hospital landscape in Switzerland, where 40 per cent of hospitals are private. Citizens have a great deal of freedom in choosing a care provider, a feature to which they are strongly attached. Only eight per cent of them would be ready to give up their freedom of choice if it could lower the costs of the health care system.

The speed with which patients are admitted is quite spectacular. Waiting is for all practical purposes nonexistent, as the most recent data from the Commonwealth Fund's international study show. Over the past year, only four per cent of Swiss had to wait six days or more before being able to see a doctor when they needed to, whereas 40 per cent of Quebecers were forced to wait that long. In 2011, getting an appointment with a medical specialist took an average of 11 days for a Swiss patient, versus 78 days for a Quebec patient.

A criticism often levelled against the Swiss health care system is that it is an expensive system. In 2009, total health care expenses represented 11.4 per cent of GDP in Switzerland… and 11.4 per cent in Canada. These figures are deceptive, however, insofar as the percentage of the population aged 65 or older is significantly higher in Switzerland (17.8 per cent) than in Quebec (15.4 per cent).

Reforms based on market mechanisms have brought concrete improvements to the health care system and very few people are dissatisfied with them. According to a recent poll, 71 per cent of citizens want the health care system to turn even more toward market solutions, versus barely 22 per cent who want more government control.

When all is said and done, the Swiss experience shows once again that the private sector can contribute constructively and efficiently to the provision of services within a public health care system without threatening the goals of fair and universal access to care.

Michel Kelly-Gagnon est président et directeur général de l'Institut économique de Montréal. Il signe ce texte à titre personnel.