Tuesday, March 6, 2007

Should Canada support private-sector healthcare?

With so much focus on the environment and the war in Afghanistan, many Canadians have lost sight of what until recently, had been the issue foremost in Canadians minds. But health care is, and should remain, an issue that stays at the forefront of the political debate.

Canada, like most Western nations, has a rapidly aging population and virtually zero population growth. Over the past century we have also had a significant improvement in our overall standard of living and quality of life. As a result, people are living longer. Combined these factors may be creating a perfect storm in the health care industry. As the population ages they will need more care and will also likely need more treatment. At the same time, health care workers are becoming increasingly scarce, and drugs increasingly more expensive.

So it was interesting to read BC Health Minister George Abbott's view of private-sector health in Gary Mason's commentary in today's Globe & Mail ("B.C. is refreshingly candid on private-sector health care"). Mr. Abbott believes that "a vigorous private-sector alternative is an advantage to the public system as a whole." He also believes that we should consider a more market based approach that is advocated by Brian Day (new head of the CMA) and used extensively in Europe. Under this system hospitals would essentially act as private corporations that would compete -- for patients and funding.

I for one agree with Mr. Abbott that we need to look for alternatives in health care delivery. The currently system is unsustainable. And private delivery already exists under Medicare -- after all GP's are really just small business owners who compete for patients and bill the government. We should even look beyond physicians to supporting services. During the past federal election, I was campaigning for a candidate in a Toronto riding. At one door, I encountered a Conservative supporter who had run a radiology clinic, but was shut down by the province and the services were moved to Markham. He claimed (I have no way of verifying this of course) that he ran the clinic more effectively and profitably -- he was open longer hours and his overall billing to the government was less.

Private delivery in this context makes a lot of sense to me -- we're just looking at efficiencies. But in doing so we have to make sure that in embracing competition, quality doesn't suffer. While Mr. Day encourages competition for patients (to reduce wait times for example), doing this without taking quality of service would be a mistake. Before embracing any private delivery strategy governments here should look to major health plans south of the border which are now looking at efficiency and quality in evaluating providers. Ensuring quality saves health plans and employers downstream costs (re-admissions, additional procedures, etc.).

One other big caveat in this private delivery scenario. We should not under any circumstances embrace private delivery outside of Medicare. And this is what Mr. Day really wants -- a U.S. style system that would allow private-sector providers to cater to those who can pay. The U.S. system is a disaster. It has drained high quality providers from the public system, left 40 million Americans without health care, and has driven many others into bankruptcy (medical bankruptcies are the number 1 cause of personal bankruptcies in the U.S.). This is no way to go. Medicare (and hopefully Pharmacare) must be retained at all costs. It ensures a reasonable quality of life for all Canadians. As a side benefit it also serves as a competitive advantage to Canadian corporations, who don't face the overwhelming costs faced by their counterparts south of the border.

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