What can Canada Learn? Adopting Policies from the EU Healthcare Systems
The health of a country’s citizens are key to maintaining economic, societal, and governmental success. It comes as no small surprise then, that establishing and maintaining an efficient, cost-effective healthcare system is something that countries constantly strive for. While the quality of healthcare is usually measured in terms of services to the general population, metrics involving policies and services for patients with rare diseases are rarely reported. Across the globe, the European Union (EU) has been one of the most generous providers of social security. In many respects, Canada lags behind the EU in terms of public health, food safety, and healthcare provision. Wait times are extremely long: it takes an average of a little more than 18 weeks for a patient to get the treatment they need.1 Healthcare costs have increased 1.6 times faster than average family income in the last decade alone.2 It currently takes over a year to access mental health services in some parts of the country.3 So what can Canada learn from the successes and failures of the EU healthcare systems?
All EU countries have universal healthcare coverage; however, they differ in many ways including coverage and outcome.4,5 Universal healthcare means that the countries are responsible for covering the medical expenses of their citizens.6 Although there is universal healthcare in all EU countries, not all healthcare services are covered. Looking at three EU countries, France, the United Kingdom (UK), and Germany, varying ranges of coverage can be observed. In France, physician and hospital services are covered in addition to outpatient care, prescription drugs, prevention (e.g. vaccines, screenings), and some dental and vision care.6 The amount patients get reimbursed, which ranges from 70-100%, depends on the type of treatment.6 Similarly, the healthcare in the UK covers in- and out-patient hospital care and drugs, as well as physician, palliative, preventative, and long-term care.7 Additionally, some dental and vision care is also covered.6 The healthcare in the UK, which is rated as the top healthcare system amongst countries such as Sweden, Australia, the US, and Canada in 2014, covers about 85% of healthcare costs.6,7
Compared to the French, UK and German models, the Canadian healthcare system covers physician and hospital care, drugs, and preventative care.5 However, prescription drugs are not covered. Thus, patients must rely on either supplementary insurance or paying out of their own pockets.5 Additionally, patients must also resort to supplementary health insurance or out-of-pocket methods for dental and vision care.6 Overall, the Canadian healthcare system only covers about 70% of the healthcare costs of Canadians.6
Another factor to consider in comparing the two healthcare systems is how they are funded and how these services are paid, which can impact the quality of care of patients. In France, healthcare is funded through a variety of courses including payroll taxes, taxes on tobacco and alcohol, and a “general social contribution.”6,8 The general social contribution takes into account the total income of citizens, including investments and lottery winnings.8 Alternatively, the healthcare in the UK and Canada are mainly funded through income and sales taxes.6 One of the main differences between these two healthcare models is how physicians are paid. Physicians in the EU are paid through a blended method of salary, capitation, and pay for performance, with a heavy emphasis on capitation.6,9 Physicians in countries that use capitation in primary healthcare, such as the UK and Germany, are motivated to care for many patients while limiting the amount of unnecessary secondary referrals and treatments, thus being more cost-effective.6,9
In contrast, the fee-for-service method for paying Canadian physicians ties the wages of physicians to the number of patients they see, thus quantity of care given may be the goal rather than quality.6 Furthermore, there is an annual budget for the healthcare system, which controls aspects such as wages for healthcare professionals, medical supplies, and equipment.6,9 Consequently, to control costs, the healthcare system is subjected to make cuts towards spending on these crucial aspects.6,9 Ultimately, the quality of care towards patients suffers which can be demonstrated by Canada’s healthcare system being rated as the worst “timeliness of care” by Forbes in 2014.7
Overall, countries in the EU emphasize a more integrated and holistic approach to providing care to people, as their primary healthcare involves an entire team of healthcare professionals such as dieticians, physiotherapists, occupational therapists, and pharmacists.10 This integrated method allows an overall assessment of the patient’s health, which could be used as a tool for prevention. This integrated approach can be seen as a model system as several EU countries produce many positive outcomes such as a high life expectancy at birth (EU average of 81.23 years) and a low infant mortality rate (EU average of 4 deaths per 1,000 live births) in a more cost-effective way than Canada.9-11 By implementing this type of system into their healthcare system, Canadians can experience these positive outcomes while reducing the amount of healthcare spending.
Healthcare for the general public is always in the spotlight whenever issues of healthcare arise; however, what about patients battling rare diseases? How do these systems compare when it comes to treatments, research, and overall action towards rare diseases? In 1999, the EU launched a four-year program with the aim to increase knowledge and access to information about rare diseases.12 In the years following, there were subsequent programs aimed at improving healthcare in the area of rare diseases.12 Throughout those years, several resources were introduced to help people understand rare diseases and the symptoms, causes, preventions, and treatments that are associated with them.12 Among the resources is the online database Orphanet, where these pieces of information can be found in addition to information about ongoing research and support groups for rare diseases.13 This database is updated bimonthly and as of March 2016, it has expanded to include 5,833 rare diseases.14 In addition to this informative network, the EU introduced the EU Orphan Drug regulation in 2000, which contained incentives for further research into rare diseases and possible pharmaceutical therapeutics.12
In contrast, Canada is the only developed country in the world that does not have a federal policy for rare diseases.15 Consequently, research on rare diseases and their treatments are less likely to occur since the patient population is not enough to drive pharmaceutical companies to invest in them.15 Currently, only 60% of orphan drugs are available in Canada and they are approved six years after the US.16 However, there are steps being taken to increase research and access to healthcare services for rare diseases, such as the accessibility of orphan drugs.15
The Canadian healthcare system needs to take more strides towards understanding the importance of not just good healthcare for the average patient, but also for the 1 in 12 Canadians battling rare diseases.16 The aim for Canadian healthcare regarding rare diseases should be towards researching ways of early detection, progression, and treatment.16 There should also be initiatives in place, such as an Orphan Drug policy that is implemented in most developed countries (e.g. countries in the EU, the US).15 Developing and implementing these policies can lead to the increase in availability of services for people battling rare diseases and those who are indirectly affected. By developing a comprehensive strategy to increase awareness, research, and availability of services for rare diseases, Canada can begin to move towards a more inclusive and improved healthcare system.
1. Waiting Your Turn: Wait Times for Health Care in Canada, 2015 Report. Fraser Institute. https://www.fraserinstitute.org/studies/waiting-your-turn-wait-times-for-health-care-in-canada-2015-report. Published December 8, 2015.
2. The Price of Public Health Care Insurance: 2015 Edition. Fraser Institute. https://www.fraserinstitute.org/studies/price-public-health-care-insurance-2015-edition. Published August 20, 2015.
3. Children’s Mental Health Ontario - About Us - CMHO Report Card. http://www.kidsmentalhealth.ca/about_us/cmho-report-card-2015.php.
4. Universal Health Care around the world. Chartsbin. http://chartsbin.com/view/z1a.
5. Kleinert S., Horton, R. Health in Europe—successes, failures and new challenges. The Lancet. 2013; 381: 1073-1074.
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7. Munro D. U.S. Healthcare Ranked Dead Last Compared to 10 Other Countries. Forbes. http://www.forbes.com/sites/danmunro/2014/06/16/u-s-healthcare-ranked-dead-last-compared-to-10-other-countries/#32c0a9241b96. Published June 16, 2014.
8. Chevreul K, Durand-Zaleski I, Bahrami S, Hernandex-Quevedo C, Mladovsky P. France: Health System Review. Health Systems in Transition. 2010; 12(6), 98-100.
9. Blomqvist A, Busby C. Better Value in Money for Heathcare: European Lessons for Canada. C.D. Howe Institute of Commentary. 2012; 339.
10. MacKinnon J. Why the European healthcare system works better than Canada’s. Troy Media. http://www.troymedia.com/2013/05/04/why-the-european-healthcare-system-works-better-than-canadas/. Published May 4, 2013.
11. Health > Life expectancy at birth > Total population. Nation Master. http://www.nationmaster.com/country-info/stats/Health/Life-expectancy-at-birth/Total-population#graph. Published March 28, 2011.
12. Rare Disease Policy. EURORDIS Rare Disease Europe. http://www.eurordis.org/eu-rare-disease-policy#tabs-1.
13. Ayme S, Schmidtke J. Networking for rare disease: a necessity for Europe. Bundesgesundheitsbl - Gesundheitsforsch – Gesundheitsschutz. 2007; 50: 1477–1483.
14. Orphanet, Orphanet. http://www.orpha.net/consor/cgi-bin/index.php.
15. About Rare Disease. iBellieve Foundation. http://ibellieve.com/about-rare-disease/.
16. Canadian Organization for Rare Disorders. CORD. https://www.raredisorders.ca/.
Cite This Article:
Macatangay K., Zheng K., Chan G., Ho J. What can Canada Learn? Adopting Policies from the EU Healthcare Systems. Illustrated by C. Scavuzzo. Rare Disease Review. August 2017. DOI:10.13140/RG.2.2.34537.08808.