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Canadian Doctor: Dutch Health Care System Could Work In U.S.

Sep 25, 2009

Canada’s health care system is often cited as a worst case scenario by Americans who insist current efforts to overhaul the U.S. health system will lead to "socialized medicine:" a single-payer system and rationed care. Dr. Robert Ouellet, the immediate past president of the Canadian Medical Association, takes exception with that view. He says that Canadians “are not dying in the street” because of wait times or access issues. The country’s universal health care system, he counters, is an important “cultural” value. Still, he acknowledges the challenges with his country’s health system. Ouellet, a radiologist, recently participated in a fact-finding mission to five European countries to learn ways to improve the Canadian system. What he found, he said, could also offer lessons for the United States. 

Kaiser Health News' Andrew Villegas recently talked with Ouellet about what he learned. Here are edited excerpts of the interview:

Q: Your five-country tour included England, Belgium, the Netherlands, France and Denmark. Why these nations?

A: There's a mixture of different ways of funding. Some are tax-funded like England and Denmark. Others like France, the Netherlands and Belgium, are social instruments. We selected the countries because the cost of their health care is similar to ours. Also, because they don't have significant wait times, or at least they have reduced their wait times. We wanted to know how they did that because this is the main problem we have in Canada.

Q: Which country offers the best model for the United States?

A: A system like the Netherlands is interesting because it could work in your country. [The Dutch ] system is run by private insurance companies, six insurance companies. Some are for-profit and some are not-for-profit. It's not the government that is running the health care system, it is those companies. But they have rules. The first one is that it's compulsory to be insured. No company can refuse any patient. And if the patient is low income then the government will pay the premium. So the result is every patient is on the same level and has the same importance, because the money follows the patient. What they are doing is what they call "managed" competition. So as you can see, it's a bit different from what you have in the United States right now. But I was thinking it might work for you.

Q: Do you think there's room for this same sort of competition in the United States between public and private plans?

A: It could be one solution. In the Netherlands and some other countries … the state is paying the premium for those who cannot afford it. It's not a [public] system in competition with the private system. It's a way of doing things. I'm not saying what your president is proposing is bad. But what they are doing in those countries is instead of creating a public system or public insurance, the [government is] paying the premiums.

Q: When you look at the Canadian system, since the adoption of universal care, have things changed significantly? What's driving you to push reform? Has it gotten off track from what it was intended to do?

A: Yes, the problems, I believe — we have a good system, we have good quality in our system, we have good outcomes — are the wait times. And our campaign this year at the Canadian Medical Association is to transform our system because [those waiting times] are not acceptable.

We need to give our system a little dose of competition, but not to change the complete system. It's not in our culture. The most important thing we want to keep is the universal access. This is very important for us, and everyone agrees on that.

Q: In the United States, we’ve heard a lot of negative things said about the Canadian health care system. How do you respond?

A: First, people are not dying on the streets in Canada. I think there is a lot of exaggeration in what we have seen in the ads in the United States about the Canadian system. We have a problem of access and we want to fix that, that's for sure. We're not denying patients care because they don't have money. We have good quality. Many doctors, I am one of them, went to the United States for training. So it's not fair to say our system is so bad. That's not true.

Q: Would the United States be well-advised to adopt some of the Canadian ways of doing health care?

A: I think so. The most important thing for us is to keep our system universal. If it is one value that you want to import, that's fine. But it doesn't mean you need to import all [of our system] because it won't work in the States. And it's the same for us. You have good things in your system. But we don't want to have your system here in Canada. This is why we went to some European countries, to look at something different. And the first value we were looking for is universal access.

Q: What do you think about the chances of overhauling the health system in America?

A: You know, you're the number one country in the world. But to have 46 million Americans who don't have insurance coverage or coverage for health care, for me, it's not acceptable. But we need to improve both of our systems. And maybe we should look at what Europeans are doing — some solutions they have used — because they have universal coverage and their costs are much lower.

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