Notre système de santé vue de l'extérieur

Une étude sur différents systèmes de santé dans le monde, voici la portion canadienne:

Canada has a compulsory NHI program administered by each of its 10 provinces. The national and provincial general tax revenues are used to finance this federal decentralized NHI system. In all provinces, there is a governmental authority in charge of the hospital insurance program. There are variations in arrangements for patient ambulatory care.

The NHI program provides first-dollar coverage, and no limit is imposed on the level of medical benefits an individual can receive during his or her lifetime. There is no copayment or deductible. Patients are not required to pay a proportion of their medical bills. The first-dollar coverage includes a comprehensive package of hospital and medical services. Physicians in ambulatory care and in hospitals are commonly paid on a fee-for-service basis, according to fee schedules negotiated between physicians' associations and provincial governments.

There are few private, for-profit hospitals in Canada. Most acute-care hospitals in Canada are legally private, nonprofit institutions. Their operating expenditures are financed through the NHI system, and most of their capital expenditures are financed by the provincial governments. The financing is through a complex shared federal and provincial tax revenue formula. A strength of the Canadian NHI is comprehensive coverage of the population.

A major weakness of the system is that, with respect to economic efficiency:

1.       The hospital, the physician, and the patient have no incentive to be economical in the use of health care resources.

2.       The dependency on central control and lack of incentives at the individual level result in inefficient use of health resources.

3.       Patients consider medical care as free public goods or services.

4.       They have no incentive to choose cost-effective forms of care.

5.       There is no incentive for a patient to use community health centers rather than rush directly to the emergency department when he or she is in need of urgent care.

Waiting replaces financial cost as a regulator of demand. Although the province authorities tightly control the global health care budgets, physicians lack incentives to use health resources efficiently.

1.       There are no incentives for providers to evaluate service levels and the kinds of therapy performed in relation to improving health status.

2.       There are no incentives for altering input mixes to affect practice style. Health care providers and a single payer tend to support the status quo.

3.       On the one hand, providers organized in strong associations have strong monopoly power, which they use to defend their legitimate interests; on the other, the monopoly power of sole-source financing (NHI) keeps provider interests in check at the cost of not intervening in the organizational practice of medicine.

Je crois, que c'est un bon résumé de notre système de santé actuel.

Réf: ECONOMIC ASPECT OF HEALTH CARE SYSTEMS: Advantage and Disadvantage Incentives in Different Systems