The Canadian Health Services Research Foundation is a nonprofit public policy research organization established with endowed funds from the Canadian government and its agencies. Their competent and scholarly analyses of health policy and financing provide a counterpoint to the dishonest and mendacious "research" produced by corporate and ideologue-funded institutions such as the Fraser Institute. In an excellent series of briefs, CHSRF researchers refute many of the myths about the Canadian health system and publicly-financed health care in general (often cited in US misinformation)
For example:
There’s an old idea that frequently sparksdebate: that patients rampantly abuse the healthcare system.
They indulge in unnecessary,expensive medical procedures all becausethey can get them for free. So why not teach Canadians to be more responsible by making them pay a charge for every health service used?
Research has long proven that user fees won’t eliminate inappropriate care nor do much to reduce costs, and even the claim that patients
waste healthcare resources is faulty.
Patients abusing health services? The true story
Robert Evans, a health economist at the University of British Columbia, explains: medical procedures are not hotcakes. People aren’t going just because someone else is paying for the resources. Institutional and hospital care, physician visits, prescription drugs, and other medical services, make up most of total Canadian health spending.
But most of that spending is beyond a patients control - Many visits to doctors, all hospital care and prescription drugs, can only be given on a doctor’s order.ii
That means patient-initiated abuse happens mostly during physician visits — which made upabout 13.5 per cent of total health spending in 2000.
But roughly half of physician services are referrals, or call-back visits to the same doctor,says Evans.
So "first visits" initiated by patients probably made up about six to seven per cent of
all spending. Since most of these visits are reasonable,
Evans estimates patient-initiated abuse is probably about one to two per cent of total spending — hardly rampant.
Tried, tested and quite untrue
In any case, user fees are unlikely to reduce costs.
Researchers found that user charges — implemented
in Saskatchewan in 1968 and abolished
seven years later — reduced the annual use of
physician services by about six per cent. But
this happened mainly because the elderly and
the poor saw about 18 per cent less of their
doctors.iii What’s more, Saskatchewan’s overall
healthcare costs didn’t shrink — thanks to
physician fee increases and people with higher
incomes, who saw their doctors more often.ii
The fees also didn’t affect the cost of hospital
services, the most expensive form of care.
Another famous study on user fees is the U.S.
Rand Health Insurance Experiment, which
assigned individuals to insurance plans with different
rates of user fees.iv Researchers found
people got less medical care in those plans with
heavier charges. But the proportion of inappropriate
antibiotic use, hospital stays and admissions
was the samev vi — with or without user fees —
proving that the fees don’t solve such problems.
ii
The fees also didn’t affect the cost of hospital
services, the most expensive form of care.
Another famous study on user fees is the U.S.
Rand Health Insurance Experiment, which
assigned individuals to insurance plans with different
rates of user fees.iv Researchers found
people got less medical care in those plans with
heavier charges. But the proportion of inappropriate
antibiotic use, hospital stays and admissions
was the samev vi — with or without user fees —
proving that the fees don’t solve such problems.
What changed was the way high-risk and lowincome
patients used medical services. Everyone
used fewer medical services, but the decline was
greater among poorer people. Sick people were
also more likely to die when user charges were
installed.vii
However, Rand investigators found healthcare
costs for people who paid user fees were lower
than people with total health coverage. This seems
to prove user charges at least lowered costs. But
that disputes the findings in Saskatchewan, where
costs didn’t decrease. Why?
While the Saskatchewan experience affected all
patients, Rand involved a dispersed group of
5,800 people, so each doctor only had a few
patients enrolled in the study. That’s not enough
to provide evidence on the effect of user fees on
the system. Therefore the Rand experiment,
unlike the Saskatchewan experience, does not
address the question of overall costs. We just
can’t conclude from Rand that healthcare costs
would drop across the system; the evidence
simply isn’t there.
Penny wise, pound foolish?
But both studies do confirm it’s mostly the poor
who use less medical care when forced to pay
extra charges. In the long run that would probably
cost more, because the old and poor are less
healthy than other groups.
In Quebec, for instance, when the elderly and
people on welfare had to pay user fees for prescription
drugs, they took less medicine. But that
resulted in sicker patients and more visits to hospital
emergency departments.ix These findings
echo earlier research, which showed that user
fees helped reduce costs in the short term, but
eventually led to more spending because more
people would neglect to get early treatment.
Despite the rhetoric, user fees don’t lead to a
more affordable health system. Research has
shown time after time that user fees inevitably
create advantages for the rich and healthy while
making matters worse for the sick and poor.