Senior Fellow, The Fraser Institute
Nadeem Esmail is the Director of Health Policy Studies at the Fraser Institute. He first joined the Fraser Institute in 2001 and served as Director of Health System Performance Studies from 2006 to 2009. Between 2009 and 2012 he was a Senior Fellow with the Institute and rejoined as a full-time staff member in late 2012. Esmail has spearheaded critical Fraser Institute research including the annual Waiting Your Turn survey of surgical wait times across Canada and How Good Is Canadian Health Care?, an international comparison of health care systems. In addition, Esmail has authored or co-authored more than 30 comprehensive studies and more than 150 articles on a wide range of topics including the cost of public health care insurance, international comparisons of health care systems, hospital performance, medical technology, and physician shortages. Esmail is a frequent commentator on radio and TV, and his articles have appeared in newspapers across North America. Esmail completed his B.A. (Honours) in Economics at the University of Calgary and received an M.A. in Economics from the University of British Columbia.
The so-called "jewel of Canada's health system" is, in fact, exactly what sets us apart from the top-performing universal access health care systems across the developed world. Freeing patients to seek care on their own terms with their own resources actually more closely follows the European approach to health care where universally insured residents of countries like Sweden, Switzerland, Germany, the UK, and others have always had the option to choose private parallel care.
Those opposed to market-based health care reform do their best to scare Canadians. Reality, however, is considerably different. International experience suggests that private competition is a fundamental feature of a high-performing, universal access health care system. For evidence, consider the Dutch health care system where private (and even for-profit) insurance companies, private providers, activity-based funding and cost sharing combine to provide more timely access to high (if not higher) quality care than Canada's system for similar cost.
06/25/2014 05:36 EDT
Experience suggests that policies like fat/'junk food' taxes, vending machine bans, menu labelling requirements, reduced availability of particular foods, simplified or directive food labels, graphic warning labels, zoning restrictions, and advertising restrictions, will not be successful at reducing the prevalence of excess weight.
05/13/2014 12:48 EDT
That a considerable number of Canadians traveled and paid to escape the well-known failings of the Canadian health-care system speaks volumes about how well the system is working for them. It leaves open the question of just how many more Canadians might choose medical tourism outside Canada if given the opportunity.
12/21/2013 05:11 EST
One irony of Canadian life is that the most economically free province in the country, Alberta, often has government policy that is the most hostile to private health care. Another irony, this time right across Canada, is that one can spend any amount of money on a basic necessity of life such as food.
12/03/2013 04:00 EST
Focusing only on the cost increases associated with stronger (but still lagging) intellectual property protection for pharmaceutical innovators is simplistic and wrong. It is the balance of these costs and benefits that are the ultimate determinant of whether or not Canadians are better off, not just the post-2023 increase in drug costs to provincial governments, patients, and insurers.
11/14/2013 05:32 EST
Canada's health expenditures as a share of the economy are, after accounting for our younger population, higher compared to every other developed nation with universal health insurance. Yet Canadians endure some of the longest delays for emergency care, primary care, specialist consultations, and elective surgery in the developed world.
11/06/2013 05:43 EST
Canadian regulations clearly restrict access to new medical innovations by placing a general ban on their use until Health Canada completes duplicate reviews already undertaken (earlier and faster) by regulators in Europe and the U.S. Regulators in these jurisdictions bear responsibility for the health and safety of populations that dwarf Canada's population of less than 35 million. Canada's current approach imposes considerable delays on Canadians struggling with illness. A closer look suggests the delays did much more than cause needless discomfort.
10/03/2013 08:04 EDT
The Canadian health care system <em>is not free</em> -- in fact, Canadian families pay heavily for healthcare through the tax system. That high price paints the long wait times and lack of medical technologies in Canada in a very different light.
08/09/2013 05:32 EDT
As part of their struggle with budget realities and the growing cost of health care, Canada's provinces continue to work on bulk purchasing agreements for pharmaceuticals as a way to save money. Unfortunately, the recent release from the Council of the Federation (the council of Canada's premiers) suffers from the typical one-sided approach that characterizes much of the drug policy discussion. Yes, there are up front savings to be had. But there's no such thing as a free lunch.
08/03/2013 07:06 EDT
Waiting is a defining characteristic of Canadian health care. Canadians wait, often interminably, for access to health care services. Canada's wait times are among the longest in the developed world. And, contrary to popular belief, Canada's terrible wait times are not the result of insufficient health care spending. In 2009 (the most recent year for which comparable statistics are available), Canada's health care system ranked as the developed world's most expensive universal-access system. The solution to Canada's waiting time woes is sensible health policy reform that would employ private competition in the delivery of universally accessible hospital and surgical services .
07/23/2013 12:28 EDT
Health associations have long been calling for a "fat tax"; taxes on foods that some nutritionists and researchers don't want us to eat or drink. Unfortunately, the lack of sound thinking behind vilifying sugary drinks or less healthful snacks has not changed, nor has the blunt, imprecise, and unfair nature of a "junk food" or "sugary drink" tax. Overly simplistic solutions to obesity that vilify an industry or food product are bad public policy. The reality is that "junk food" taxes or sugary drink taxes are ineffective instruments that fail to recognize the complex and manifold causes of obesity. It's time we put the idea of such taxes in their rightful place: the junk bin.
07/15/2013 12:51 EDT
Every year, provincial health care systems across Canada dutifully reduce the volume of services they provide in preparation for the summer vacation season. This planned-for reduction has the inevitable effect of lengthening waiting times for Canadians over the summer months (and during Christmas holidays). The added twist this year is the slowdowns might be extended in a bid to reduce expenditures.
06/20/2013 05:14 EDT
Bulk purchasing of pharmaceuticals has attracted significant attention of late as Canada's provinces work to balance access to medicines and their benefits with budgetary realities. Unfortunately for Canadians, insufficient consideration is being given to the tradeoffs and risks associated with bulk purchasing agreements.
05/24/2013 05:30 EDT
We would wager citizens of every country think health care could be improved. However, we would also bet a plane ticket to someone's favourite summer getaway that Canadians will find countries with universal health care, such as Australia, Japan, or favourite tourist destinations in Europe, have far better health care than we do. That's because their citizens and their governments have no hang-ups about the three boogeymen of upfront fees, "private" insurance, and private delivery. They are also nations with progressive, sensible health care practices that could help improve Canada's health care system.
05/22/2013 12:11 EDT
Canadian taxpayers are not receiving the same sort of value that their counterparts in other nations are when it comes to universally accessible health care. In fact, Canadians spend much more for their health care and receive lower quality care than other countries with universal-access systems.
05/15/2013 08:12 EDT
New medicines are a central component of modern medical care. Unfortunately for Canadians, our federal government takes an approach that is slower than others, unnecessarily costly for taxpayers, and is ultimately of questionable benefit to Canadians. Canadian approvals for market access to new drugs take longer than similar approvals in both Europe (under the European Medicines Agency) and the U.S. (under the FDA). Specifically, the median approval time was longer in Canada than in the other jurisdictions in four of the past five years. But would faster approval of new drugs expose us to greater risk? Perhaps.
05/02/2013 08:02 EDT
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