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加拿大医疗政策的失败：问题出在哪里？谁受到了伤害？为什么什么都没有改变
作者：Brett Skinner – 2009年9月21日
加拿大的医疗政策越来越辜负患者和纳税人的期望。与同类国家相比，加拿大人在医疗保健方面的支出很高。然而，我们相对较高的支出水平并不能为加拿大人带来与其他国家患者同等的医疗资源。医疗资源短缺，以及加拿大医疗体系内部不合理的经济激励机制，导致越来越多的患者等待获得公共资助的、医疗必需的产品和服务。
现有证据表明，加拿大的轮候时间比几乎所有其他可比国家都要长。我们的高额支出不仅未能改善医疗保健的可及性，政府医疗支出的增长速度也超过了我们仅靠公共手段支付医疗费用的能力。
这导致医疗保健消耗了政府可用收入的越来越大份额，而用于其他公共责任和义务的可用收入却相应减少。经济研究和国际经验表明，经济自由化的政策替代方案可以显著改善加拿大医疗体系的财务可持续性和资金投入的性价比。
在加拿大引入此类政策的预期结果是减少轮候时间，并增加获得医疗专业人员、医疗技术和新药的机会。大多数其他国家与加拿大有着共同的社会目标，即公开保障全民医疗保险，它们正在越来越多地在其医疗体系中引入经济自由化的改革。
加拿大则反其道而行之，有效地禁止了公共资助服务的使用者付费、医疗机构在公共费用水平之上的额外收费，以及医生和医院服务的私人支付或私人医疗保险。然而，这些政策的全部或部分已在其他同样实行公共保障全民医疗保险制度的国家得到成功实施；这些国家在经济效率和财政可持续性方面都比加拿大更能更好地获得医疗资源。尽管医疗改革面临政治障碍，但仍有几个理由保持乐观。
虽然《加拿大健康法》（CHA）对经济自由化政策改革构成了部分障碍，但该法案仍然赋予了令人惊讶的自由度，而且各省最终如果选择行使政策自主权，仍然拥有政策自主权。医疗政策自由化作为多党制中的楔子问题，其性质也表明，改革纲领可以成为一种制胜的选举策略。各种民意调查的结果表明，如果提出正确的问题，大多数加拿大人实际上可能倾向于经济自由化和社会简约主义的医疗政策方法。
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.
