Wednesday, April 7

Une bonne idée pour la santé

The Quebec government is mulling over an excellent idea that could improve public health care: deductibles.

In Canada, medical care is free, in that you don't have to pay when you go to the doctor. Some provinces (including Quebec, starting on July 1) charge a mandatory tax specifically for health care, but it's either a flat tax or dependent on income. The difference with Quebec's proposal is that it would be based on how much an individual uses medical services.

There are two reasons why deductibles are a good idea. First, they encourage people to take good care of themselves. I know if I bang up my car, I'll have to pay a $1,000 deductible before the insurance company hands over a penny, so I drive a little more carefully. Similarly, if I have to pay every time I go to the doctor, I might take a little better care of myself to avoid having to visit as often.

The second reason why deductibles are good is they can encourage more efficient use of a product. One of the problems with free health care is that free products tend to be overused. I know I've visited the doctor when I've had a run-of-the-mill flu or fever, only to be told to go home, get lots of rest, drink lots of fluids, and perhaps pop a couple Tylenol. Meanwhile, we have long waiting lists for important surgeries. If we charged people a small amount for visiting the doctor, we'd cut down on some of the more frivolous uses of health care.

Of course, it would be very important not to set a deductible too high. While it's not a big deal if someone drives around with a dent in their car because they don't want to pay the deductible on their car insurance, we don't want people to ignore a breast or prostate lump because of a high health care deductible. And in the interests of fairness, the government could also create discounts or exemptions for low-income people and citizens who have a particularly high usage of the health care system.

As good as it seems, I'd be surprised if Quebec actually implements this proposal. In addition to possible violations of the Canada Health Act, it sounds like it's a pretty unpopular proposal. But when the World Health Organization ranks our health care system 30th in the world, there is lots of room for unpopular new ideas.