Competition in Canadian Health Care Service Provision: Good, Bad, or Indifferent?

Most provincial health care systems in Canada combine public, private non-profit, and private for-profit delivery. In Alberta, the Health Care Protection Act, known as Bill 11, allows the public to purchase certain insured surgical services from private providers. This legislation sparked a heated and ongoing debate in Canada about the role of competition in health care service delivery. The key question asked is what can be gained from introducing competition among hospital and physician services while maintaining a public payment system. This paper evaluates what has been learned from the recent literature on competition in health care markets in the context of expanding the role of the private sector in Alberta. The evidence does not provide a definitive answer. Competition introduced by an expanded private sector is likely to be beneficial on some measures, indifferent on others, but not likely bad.