Fraser Institute
Australia’s universal health-care system outperforms Canada on key measures including wait times, costs less and includes large role for private hospitals
The Role of Private Hospitals in Australia’s Universal Health Care System
From the Fraser Institute
by Mackenzie Moir and Bacchus Barua
In the wake of the COVID-19 pandemic, provincial governments across Canada relied on private
clinics in order to deliver a limited number of publicly funded surgeries in a bid to clear unprecedented
surgical backlogs. Subsequently, surveys indicated that 78% of Canadians support allowing more
surgeries and tests performed in private clinics while 40% only support this policy to clear the
surgical backlog. While a majority of Canadians are either supportive (or at the very least curious)
about these arrangements, the use of private clinics continues to be controversial and raise questions
around their compatibility with the provision of universal care.
The reality is that private hospitals play a key role in delivering care to patients in other countries with universal health care. Canada is only one of 30 high-income countries with universal care and many of these countries involve the private-sector in their health-care systems to a wide extent while performing better than Canada.
Australia is one of these countries and routinely outperforms Canada on key indicators of health-care performance while spending at a similar or lower level. Like Canada, Australia ranked
in the top ten for health-care spending (as a percentage of GDP and per capita) in 2020. However, after adjusting for the age of the population, it outperforms Canada on 33 (of 36) measures of performance.
Importantly, Australia outperformed Canada on a number of key measures such as the availability of physicians, nurses, hospital beds, CT scanners, and MRI machines. Australia also outperformed
Canada on every indicator of timely access to care, including ease of access to after-hours care, same-day primary care appointments, and, crucially, timely access to elective surgical care and specialist appointments.
Australia’s universal system is also characterized by a deep integration between the public and private sectors in the financing and delivery of care. Universal health-insurance coverage is provided through its public system known as Medicare. However, Australia also has a large private health-care sector that also finances and delivers medical services. Around half of the Australian population (55.2% in 2021/22) benefit from private health-insurance coverage provided by 33 registered not-for-profit and for-profit private insurance companies.
Private hospitals (for profit and not for profit) made up nearly half (48.5%) of all Australian hospitals in 2016 and contain a third of all care beds. These hospitals are a major partner in the delivery of care in Australia. For example, in 2021/22 41% of all recorded episodes of hospital care occurred in private hospitals. While delivering a small minority of emergency care (8.2%), private hospitals delivered the majority of recorded elective care (58.6%) and 70.3% of elective admissions involving surgery.
Private hospitals primarily deliver care to fully funded public patients in two ways. The first is contracted
care, either through ad hoc inter-hospital contracts or formal programs. Fully publicly funded episodes of care occurring in private hospitals made up 6.4% of all care in private hospitals, while representing 2.6% of all recorded care. The second way is privately delivered care paid for through the Department of Veterans’ Affairs. A full 73.5% of care paid for by the Department of Veterans’ Affairs occurred in private hospitals.
It would be easy, however, to underestimate the significance of this public-private partnership by examining only the delivery of care that is fully publicly funded. Privately insured care is also partially subsidized by the government, at a rate of 75% of the public fee. Therefore, in order to understand the full extent of publicly funded or subsidized care in private hospitals, it is helpful to examine private hospital expenditures by the source of funds. In 2019/20, 32.8% of private hospital expenditures came from government sources, 18.2% of which came from private health-insurance rebates. This means that a full
third of private hospital expenditure comes from a range of public sources, including the federal government.
Overall, private hospitals are important partners in the delivery of care within the Australian universal healthcare system. The Australian system outranks Canada’s on a range of performance indicators, while spending less as a percentage of GDP. Further, the integration of private hospitals into the delivery of care, including public care, occurs while maintaining universal access for residents.
Authors:
More from this study
Business
Fuelled by federalism—America’s economically freest states come out on top
From the Fraser Institute
Do economic rivalries between Texas and California or New York and Florida feel like yet another sign that America has become hopelessly divided? There’s a bright side to their disagreements, and a new ranking of economic freedom across the states helps explain why.
As a popular bumper sticker among economists proclaims: “I heart federalism (for the natural experiments).” In a federal system, states have wide latitude to set priorities and to choose their own strategies to achieve them. It’s messy, but informative.
New York and California, along with other states like New Mexico, have long pursued a government-centric approach to economic policy. They tax a lot. They spend a lot. Their governments employ a large fraction of the workforce and set a high minimum wage.
They aren’t socialist by any means; most property is still in private hands. Consumers, workers and businesses still make most of their own decisions. But these states control more resources than other states do through taxes and regulation, so their governments play a larger role in economic life.
At the other end of the spectrum, New Hampshire, Tennessee, Florida and South Dakota allow citizens to make more of their own economic choices, keep more of their own money, and set more of their own terms of trade and work.
They aren’t free-market utopias; they impose plenty of regulatory burdens. But they are economically freer than other states.
These two groups have, in other words, been experimenting with different approaches to economic policy. Does one approach lead to higher incomes or faster growth? Greater economic equality or more upward mobility? What about other aspects of a good society like tolerance, generosity, or life satisfaction?
For two decades now, we’ve had a handy tool to assess these questions: The Fraser Institute’s annual “Economic Freedom of North America” index uses 10 variables in three broad areas—government spending, taxation, and labor regulation—to assess the degree of economic freedom in each of the 50 states and the territory of Puerto Rico, as well as in Canadian provinces and Mexican states.
It’s an objective measurement that allows economists to take stock of federalism’s natural experiments. Independent scholars have done just that, having now conducted over 250 studies using the index. With careful statistical analyses that control for the important differences among states—possibly confounding factors such as geography, climate, and historical development—the vast majority of these studies associate greater economic freedom with greater prosperity.
In fact, freedom’s payoffs are astounding.
States with high and increasing levels of economic freedom tend to see higher incomes, more entrepreneurial activity and more net in-migration. Their people tend to experience greater income mobility, and more income growth at both the top and bottom of the income distribution. They have less poverty, less homelessness and lower levels of food insecurity. People there even seem to be more philanthropic, more tolerant and more satisfied with their lives.
New Hampshire, Tennessee, and South Dakota topped the latest edition of the report while Puerto Rico, New Mexico, and New York rounded out the bottom. New Mexico displaced New York as the least economically free state in the union for the first time in 20 years, but it had always been near the bottom.
The bigger stories are the major movers. The last 10 years’ worth of available data show South Carolina, Ohio, Wisconsin, Idaho, Iowa and Utah moving up at least 10 places. Arizona, Virginia, Nebraska, and Maryland have all slid down 10 spots.
Over that same decade, those states that were among the freest 25 per cent on average saw their populations grow nearly 18 times faster than those in the bottom 25 per cent. Statewide personal income grew nine times as fast.
Economic freedom isn’t a panacea. Nor is it the only thing that matters. Geography, culture, and even luck can influence a state’s prosperity. But while policymakers can’t move mountains or rewrite cultures, they can look at the data, heed the lessons of our federalist experiment, and permit their citizens more economic freedom.
Business
Brutal economic numbers need more course corrections from Ottawa
From the Fraser Institute
By Matthew Lau
Canada’s lagging productivity growth has been widely discussed, especially after Bank of Canada senior deputy governor Carolyn Rogers last year declared it “an emergency” and said “it’s time to break the glass.” The federal Liberal government, now entering its eleventh year in office, admitted in its recent budget that “productivity remains weak, limiting wage gains for workers.”
Numerous recent reports show just how weak Canada’s productivity has been. A recent study published by the Fraser Institute shows that since 2001, labour productivity has increased only 16.5 per cent in Canada vs. 54.7 per cent in the United States, with our underperformance especially notable after 2017. Weak business investment is a primary reason for Canada’s continued poor economic outcomes.
A recent McKinsey study provides worrying details about how the productivity crisis pervades almost all sectors of the economy. Relative to the U.S., our labour productivity underperforms in: mining, quarrying, and oil and gas extraction; construction; manufacturing; transportation and warehousing; retail trade; professional, scientific, and technical services; real estate and rental leasing; wholesale trade; finance and insurance; information and cultural industries; accommodation and food services; utilities; arts, entertainment and recreation; and administrative and support, waste management and remediation services.
Canada has relatively higher labour productivity in just one area: agriculture, forestry, fishing and hunting. To make matters worse, in most areas where Canada’s labour productivity is less than American, McKinsey found we had fallen further behind from 2014 to 2023. In addition to doing poorly, Canada is trending in the wrong direction.
Broadening the comparison to include other OECD countries does not make the picture any rosier—Canada “is growing more slowly and from a lower base,” as McKinsey put it. This underperformance relative to other countries shows Canada’s economic productivity crisis is not the result of external factors but homemade.
The federal Liberals have done little to reverse our relative decline. The Carney government’s proposed increased spending on artificial intelligence (AI) may or may not help. But its first budget missed a clear opportunity to implement tax reform and cuts. As analyses from the Fraser Institute, University of Calgary, C.D. Howe Institute, TD Economics and others have argued, fixing Canada’s uncompetitive tax regime would help lift productivity.
Regulatory expansion has also driven Canada’s relative economic decline but the federal budget did not reduce the red tape burden. Instead, the Carney government empowered cabinet to decide which large natural resource and infrastructure projects are in the “national interest”—meaning that instead of predictable transparent rules, businesses must answer to the whims of politicians.
The government has also left in place many of its Trudeau-era environmental regulations, which have helped push pipeline investors away for years. It is encouraging that a new “memorandum of understanding” between Ottawa and Alberta may pave the way for a new oil pipeline. A memorandum of undertaking would have been better.
Although the government paused its phased-in ban on conventionally-powered vehicle sales in the face of heavy tariff-related headwinds to Canada’s automobile sector, it still insists that all new light-duty vehicle sales by 2035 must be electric. Liberal MPs on the House of Commons Industry Committee recently voted against a Conservative motion calling for repeal of the EV mandate. Meanwhile, Canadian consumers are voting with their wallets. In September, only 10.2 per cent of new motor vehicle sales were “zero-emission,” an ominous18.2 per cent decline from last year.
If the Carney government continues down its current path, it will only make productivity and consumer welfare worse. It should change course to reverse Canada’s economic underperformance and help give living standards a much-needed boost.
-
Alberta21 hours agoThe Recall Trap: 21 Alberta MLA’s face recall petitions
-
illegal immigration22 hours agoUS Notes 2.5 million illegals out and counting
-
International21 hours agoTyler Robinson shows no remorse in first court appearance for Kirk assassination
-
Fly Straight - John Ivison2 days agoMPs who cross the floor are dishonourable members
-
Business2 days agoThe world is no longer buying a transition to “something else” without defining what that is
-
Energy1 day agoCanada’s future prosperity runs through the northwest coast
-
2025 Federal Election2 days agoToo Close for Comfort: Carney Floor Crosser Comes From a Riding Tainted by PRC Interference
-
Business2 days agoHigh-speed rail between Toronto and Quebec City a costly boondoggle for Canadian taxpayers


