title: Workers' compensation boards and nineteenth century French railway firms.
abstract: WCBs are able to provide fast access to high-quality healthcare to workers through their role as parallel payers in a publicly financed healthcare system. On the positive side, added funding from WCBs may help public facilities to fund and keep costly medical expertise. On the negative side, WCBs may drive them to accept much-needed funding below true costs of care and to crowd out public-pay patients. Some studies showed that governments were expecting from policies supporting parallel private payers the benefits hoped for by Hurley et al, while some of their negative effects could not be avoided. The combination of cost shifting from public-pay to private-pay patients, and of crowding out, are the ingredients of a Dupuit's case wherein third-class passengers riding the nineteenth century French railway system were subsidizing first- and second-class passengers. With the pressure for allowing private financing of healthcare throughout Canada, the Canadian healthcare system may be ripe for a ride toward subsidization of private-pay patients by the public purse, with a little help from WCBs.
authors.affiliation: Département d'administration de la santé, Faculté de médecine, Université de Montréal.
authors.forename: François
authors.initials: F
authors.lastname: Béland
mesh_terms: D002170:Canada; D003284:Contract Services / Q000458:organization & administration; D005602:France; D058016:Health Facility Administration; D006291:Health Policy; D006297:Health Services Accessibility / Q000191:economics / Q000458:organization & administration*; D054625:Healthcare Disparities; D006801:Humans; D009313:National Health Programs / Q000191:economics / Q000458:organization & administration*; D009784:Occupational Diseases / Q000628:therapy*; D011332:Privatization / Q000458:organization & administration; D011787:Quality of Health Care / Q000458:organization & administration; D011890:Railroads; D014942:Workers' Compensation / Q000191:economics / Q000458:organization & administration*