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Private Clinics: No Quick Fix

Two-tier systems haven't reduced wait times.

Guy Caron 17 Aug 2007TheTyee.ca

Guy Caron is a health-care campaigner for Council of Canadians.

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In a recent policy paper, The Canadian Medical Association (CMA) made its agenda clear: to use private, for-profit clinics to "fix" waiting times, encourage the use of private health insurance and allow doctors to work in both public and private settings.

According to the CMA, private health care is the way to go.

Undoubtedly, the vast majority of Canadian doctors care first and foremost for their patients and their well-being. This does not mean that the public policies their delegates support will adequately address issues of waiting times, of access and of fairness.

The CMA showed it was heading in a disastrous new direction last year, with the election of private for-profit clinic owner Dr. Brian Day as its president-elect, the setting of policies promoting double-dipping for doctors, and the development of a "public-private interface."

This year, the doctors will be meeting in Vancouver. And while the CMA's "true" agenda has been revealed in its most recent policy paper titled Medicare Plus: Toward a Sustainable Publicly Funded Health Care System in Canada, the Council of Canadians will be closely monitoring events, hoping to engage delegates in a viable and productive debate regarding the future of public health care in Canada.

We will be sharing evidence with CMA delegates and the public that shows private for-profit health care does not alleviate waiting times. More importantly, there are solutions in the public system that can be applied nationwide. These solutions do not require spending public money on private clinic shareholders' profits.

Evidence from New Zealand and UK

Consider, for instance, the CMA support for increased privatization to alleviate wait times and facilitate access. What evidence has been raised to support the use of private, for-profit delivery of care for these goals?

None. In fact, the evidence points in the other direction. New Zealand and the United Kingdom both had a Canadian-style health care system until they opened it up to the private sector in an attempt to decrease wait times. In fact, not only was there a loss of capacity in the public system of these two countries due to the poaching of health professionals by the private sector, it was also found that specialists "may even have an incentive to maintain long waiting lists in the public sector to generate demand for services on a private basis."

As a result, the public sector market-oriented reforms of the 1990s in New Zealand were regarded as having failed to achieve their promises. While they had some success in constraining health costs, elective surgery waiting lists had grown and the view was that structural change was needed. They are in the process of adding to public health care capacity.

As for the United Kingdom, the problem was addressed in 2001 with the hiring of 4,000 health professionals by the public system as the market-based reforms lengthened the wait times.

How many examples can we find of countries that did decrease wait times after moving to a two-tier system? None.

Unfortunately, it is unlikely that this type of evidence will sway the incoming president of the CMA, Dr. Brian Day. Relishing his "Dr. Profit" moniker, Dr. Day has been steadfastly campaigning since 1996 for increased private involvement in health care. He has also called for the repeal of the Canada Health Act and for user fees.

Dr. Day tries to portray himself as a moderate who only wishes to save medicare and who pleads for a "European-style" system, but the speech he gave to the Los Angeles Association of Health Underwriters only four months ago makes obvious his intent to open up a huge private market in Canada for the American industry.

Of course, his own private for-profit Cambie Surgery Centre will benefit from this change.

Where should the CMA go?

It is fairly obvious from the evidence that profit is not the cure for Canada's health care system. Rather than supporting market "reform" that would restrict current access, doctors and delegates should look to public solutions that can strengthen the system. The Alberta Hip and Knee Replacement Project and the Richmond Hip and Knee Reconstruction Project both reduced wait times by more than 75 per cent. Both projects consolidated waiting lists, standardized processes, applied queue management theories, and reallocated resources to achieve these impressive results.

The Sault Ste. Marie breast health centre reduced the wait-time from mammogram to breast cancer diagnosis by 75 per cent by consolidating the previously separate investigations. If a woman has a positive mammogram, she often has the ultrasound, and sometimes the biopsy as well, on the same day.

Examples like these can be shared between provinces, regions and institutions. Doctors should be encouraging these innovations that are the surest way towards improving access and better resource allocation in the Canadian system.

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