Thursday, August 21, 2008

Are Private-Public Alliances the Cure for Canada's Ailing Healthcare System

The incoming head of the Canadian Medical Association , Dr. Robert Ouelett gave his inaugural address to 400 of the 67,000 physicians he represents in Canada. Dr. Ouelett envisions a private/public mix of physician services where surgeons, for instance, provide 90% of their services in a public system and 5-10% in the private.

Dr. Ouelett's position however is not without bias. He currently runs several private radiology clinics in Quebec, where they have benefited from the de-facto ban on such clinics in the neighboring province of Ontario. Ontarians have had to make the trip across the border to jump the queue for faster CT's and MRI's at private clinics like those that Dr. Ouelett runs.

The truth of the matter is that health care wait times and family doctor:population ratios have not seen significant improvement for many years. There is also good evidence that private clinics provide care with greater efficiency, albeit at greater cost. A change is required and Dr. Ouelett is a harbinger of things to come for the Canada Health Act.

The fall will likely bring a Federal election, and if the polls are to be believed, a Conservative government who is more friendly to private enterprise in the public health care system. Canadians will then have to make a choice between higher taxes, greater user fees, private clinics (owned by physicians) or private enterprise clinics (with non-physician investors).

While I agree with Dr. Ouelett's assessment that change is needed I fear that a private-public mix will generate greater inequality to the system. Canadians have been able to pride ourselves on the fact that care is rationed out with greater equality than other systems. The questions is, are we willing to fund the system so that the quality of care matches the same standards? As access to care retreats and quality suffers there will be a far greater cry for privatization than we are hearing now. The real question is how will privitazation manifest itself in Canada?

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