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加拿大醫療政策的失敗：問題出在哪裏？誰受到了傷害？為什麽什麽都沒有改變
作者：Brett Skinner – 2009年9月21日
加拿大的醫療政策越來越辜負患者和納稅人的期望。與同類國家相比，加拿大人在醫療保健方麵的支出很高。然而，我們相對較高的支出水平並不能為加拿大人帶來與其他國家患者同等的醫療資源。醫療資源短缺，以及加拿大醫療體係內部不合理的經濟激勵機製，導致越來越多的患者等待獲得公共資助的、醫療必需的產品和服務。
現有證據表明，加拿大的輪候時間比幾乎所有其他可比國家都要長。我們的高額支出不僅未能改善醫療保健的可及性，政府醫療支出的增長速度也超過了我們僅靠公共手段支付醫療費用的能力。
這導致醫療保健消耗了政府可用收入的越來越大份額，而用於其他公共責任和義務的可用收入卻相應減少。經濟研究和國際經驗表明，經濟自由化的政策替代方案可以顯著改善加拿大醫療體係的財務可持續性和資金投入的性價比。
在加拿大引入此類政策的預期結果是減少輪候時間，並增加獲得醫療專業人員、醫療技術和新藥的機會。大多數其他國家與加拿大有著共同的社會目標，即公開保障全民醫療保險，它們正在越來越多地在其醫療體係中引入經濟自由化的改革。
加拿大則反其道而行之，有效地禁止了公共資助服務的使用者付費、醫療機構在公共費用水平之上的額外收費，以及醫生和醫院服務的私人支付或私人醫療保險。然而，這些政策的全部或部分已在其他同樣實行公共保障全民醫療保險製度的國家得到成功實施；這些國家在經濟效率和財政可持續性方麵都比加拿大更能更好地獲得醫療資源。盡管醫療改革麵臨政治障礙，但仍有幾個理由保持樂觀。
雖然《加拿大健康法》（CHA）對經濟自由化政策改革構成了部分障礙，但該法案仍然賦予了令人驚訝的自由度，而且各省最終如果選擇行使政策自主權，仍然擁有政策自主權。醫療政策自由化作為多黨製中的楔子問題，其性質也表明，改革綱領可以成為一種製勝的選舉策略。各種民意調查的結果表明，如果提出正確的問題，大多數加拿大人實際上可能傾向於經濟自由化和社會簡約主義的醫療政策方法。
Canadian Health Policy Failures: What's Wrong? Who Gets Hurt? Why Nothing Changes
by Brett Skinner – Sept. 21 2009
Canadian health policy is increasingly failing patients and taxpayers. Canadians spend a lot on health care relative to comparable countries. Yet our high relative level of spending does not buy Canadians as many health care resources as patients in other countries enjoy. Shortages of medical resources, as well as improper economic incentives within the Canadian health system have resulted in growing waits for access to publicly funded, medically necessary goods and services.
The available evidence indicates that wait times are longer in Canada than in almost all other comparable countries. Not only has our high level of spending not produced better access to health care, government health spending has also been growing at rates that are faster than our ability to pay for it through public means alone.
This has resulted in health care consuming ever greater shares of the revenue available to governments, leaving proportionally less available for other public responsibilities and obligations. Economic research and international experience suggest that economically liberal policy alternatives could dramatically improve the financial sustainability and the value for money spent in the Canadian health system.
The expected result of introducing such policies in Canada would be to reduce wait times and increase access to health professionals, medical technologies and new medicines. Most other countries that share Canada's social goal of publicly guaranteeing universal health insurance coverage are increasingly introducing economically liberal reforms into their health systems.
Canada has gone the opposite direction in effectively prohibiting user fees for publicly funded services, extra-billing by health providers above public fee levels, and private payment or private health insurance for physician and hospital services. Yet, all or some of these policies have been used successfully in other countries that also have publicly guaranteed universal health insurance systems; and those countries achieve better access to health care resources on a more economically efficient and financially sustainable basis than Canada. Despite the political obstacles to health care reform, there are several reasons for optimism.
While the Canada Health Act (CHA) is a partial barrier to economically liberal policy reforms, there is still a surprising degree of freedom under the act, and ultimately the provinces still have policy autonomy if they choose to exercise it. The nature of health policy liberalization as a wedge issue in a multi-party system also suggests that a reform platform could work as a winning electoral strategy. And the results from various public opinion polls indicate that when the right questions are asked, most Canadians might actually tend to prefer economically liberal and socially minimalist approaches to health policy.
