NCPA - National Center for Policy Analysis

Canada Could Learn From Slovakia's Health Care Reforms

April 2, 2004

Countries such as Canada that provide a "free" universal health care could learn from the 2003 reform of Slovakia's health care system. The country has slowly moved from its old government-run health care to a more mixed-market approach by charging co-payments for patient health care.

  • The fees range from about $1.63 to $4.08 in Canadian dollars -- even less in terms of U.S. dollars -- for emergency services and hospitalization.
  • Due to a reduction in unnecessary doctor visits, over a four-month period last year, visits to general practitioners in Slovakia declined 30 percent while hospital stays and visits to specialists declined 25 percent.

Opponents of the fees fear that the health outcomes of patients will suffer as they may be inclined to delay visiting a doctor until their condition worsens, resulting in more costly treatments that the government must cover. However, previous research shows that copayments actually reduce overall health care costs without little effect on patient outcome:

  • A 1970 Rand study based on 2000 non-elderly families showed that charging a 25 percent copayment actually reduced overall health costs by about 19 percent, with little or no adverse health outcomes for patients.
  • However, low income individuals with certain pre-existing conditions would benefit from free health care.

The study suggests that health care systems such as Canada's could operate more efficiently with patient copayments, as long as a provision is in place for the very poor.

Others suggest that copayments, if adopted in Canada, for instance, would improve access to family physicians, eliminate long waiting lines, and free up resources from unnecessary doctor visits to treat those who are currently on waiting lists.

Source: Nadeem Esmail, "New Health Reform Policy in Slovakia Reminds Canada of a Lesson it Has Yet to Learn," Fraser Institute, February 2004, and Joseph P. Newhouse, Free for All? Lessons from the RAND Health Insurance Experiment (Cambridge, Mass.: Harvard University Press, 1993).


Browse more articles on International Issues