Empowering Healthcare Consumers

An old friend of the Frontier Centre flew into Winnipeg in the middle of November and left behind more than the winter’s first blizzard. Johan Hjertqvist’s seminar here laid out the basics of what his Belgium-based organization calls the EuroHealth Consumer Index. An ambitious attempt to benchmark the relative sensitivity of countries to healthcare consumers’ need for information, it may well represent the wave of the future.

The project’s relevance in Canada can be summed up with one person’s name: Jacques Chaoulli. The Québec doctor had sued his provincial government on behalf of a patient who faced long waiting times for orthopedic surgery. In June, Québec’s Supreme Court ruled that a longstanding ban on private health insurance violated the patient’s rights. Although the decision was later stayed for a year, to allow the provincial and federal governments time to respond, it threw down a gauntlet to our Medicare system. Canadians are tired of being pushed around.

Hjertqvist cited the case as one of several elements in the growing demand for consumer empowerment in healthcare, with escalating costs and unhappiness with waiting lists high on the list. As affluent boomers near the age at which they will max out our healthcare resources, they are increasingly intolerant of the system’s demand that they suffer in silence. If Dr. Mark Godley is willing to sell a private MRI scan at the Maples Surgical Clinic for $695, what exactly gives Health Minister Tim Sale the gall to tell people they can’t spend their own money, or even buy insurance coverage, to get it? Better they should wait months and have taxpayers provide it for $300?

After providing the intellectual ammunition for the 1990s revolution in healthcare delivery in Stockholm—splitting the purchaser from the provider, and encouraging internal markets—Hjertqvist turned to consumer empowerment. He devised the Swedish Health Index, did the research to provide its content and published his first two rounds of results. After a round of carping, public officials in Sweden’s county councils—the level of government responsible for healthcare—responded positively to the rankings.

“It prompted a new discussion about the inequalities in health care,” Hjertqvist explains. “Why do you have better access to certain treatments or shorter waiting lists in one county council or another? Many patient organizations took action based on this index and used it as a tool for advocacy in relation to the governments and medical profession. We noticed that regional governments are taking action now to improve the information they provide. Starting November 1, 2005, we have guaranteed national access, saying that you should not have to wait more than 12 weeks for any kind of treatment.”

That success, combined with the declining importance of national borders within the European Union, prompted the Swede to take the show on the road. He opened the Healthcare Consumer Powerhouse in Brussels and began to compare EU countries. Based on four standards that measure how well healthcare systems respond to service needs, the Index provides patients with the sort of information that magazines like Consumer Reports do for people buying cars or stereos.

Its components look like this:

  • Patient Rights—Are they recognized by law? Do governments provide catalogues of available providers and facilities? Is there direct access to specialists and the right to a second opinion? Is there no-fault malpractice insurance? Do patients have access to their own medical records, and can they travel to other countries for care if it’s denied at home?
  • Waiting Times—Much like the Fraser Institute’s work in Canada, the Index lists average wait times across a range of treatments. Unlike the Fraser, which gathers data from providers, the Index does it by sampling patients.
  • Outcomes—The Index compares death rates for a number of medical problems, like pediatric cardiology, maternity, and breast and colon cancer, as well as rates of infection experienced by patients.
  • Consumer Friendliness—Can you pay extra for extra services? Is there convenience of payment? Can you renew prescriptions without seeing a doctor again? Is information on facilities and services available on the Internet or 24/7 by telephone?
  • Pharmaceuticals—Are they subsidized? How easily can cheaper generic varieties be substituted for expensive patented ones? How complete is access to the newest drug remedies?
  • After assigning weights to these factors, the first Indexers discovered that three countries scored quite well, far above all others: The Netherlands, Switzerland and Germany. It’s worth noting, for the ideologues who believe the defining feature of a healthcare system is whether or not it resides in the public sector, that two of those countries fall into that category, while Switzerland—where healthcare is privately provided and funded—does not.

    That suits Hjertqvist fine. “Competition among private and public providers is the key to success,” he believes. “The private providers inject a lot of new ideas and a lot of efficiency into the system. I would say that a reasonable mix between public and private and a reasonable share for private providers within the umbrella of public funding are speeding up efficiency and the awareness of consumer attitudes and expectations.”

    It’s interesting to speculate how Canada would fare on such an Index, or where individual provinces would stand when compared with each other. We assiduously resist benchmarking of what are arguably our two most important social services, public education and healthcare. Perhaps it’s time for that to change.