Musings on Health Care

Gary Mar – the perceived front-runner in the PC leadership race – caused a stir a few weeks ago with comments to the Edmonton Sun editorial board in support of private health care delivery.

Predictably, two things happened. First, media speculation focused less on whether this was a good idea from a policy and service delivery perspective; second, public health care advocates jumped all over him and any defenders for daring to bring up the prospect of private delivery.

Many recognize that our health care system faces challenges, which will only grow in the coming years. Health care already takes up more than 40% of Alberta’s operating budget, and that figures to grow as our population ages. Sustainability – financially-speaking – is only the second biggest challenge. The first is that we seem unable to have a serious, mature dialogue about health care in Canada. Without that dialogue, we’ll never get to solving the challenge of financial sustainability.

H1N1 Clinic
An H1N1 vaccination clinic in Edmonton, from 2009.

There is some truth in what Mar says. People with means, should they be interested, will find ways to get access to timely care if the public system in Alberta is not providing it. There are an increasing number of privatized (or elective) features of health care in this province. Capturing that cost is an economic opportunity. There is nothing inherently incompatible with having private delivery happening parallel to a robust, efficient public health care system.

Where defenders of public health care fall down for me is in demonizing private delivery. I support timely, quality access to health care for everyone. The conversation in my mind is not, ‘how do we stop private delivery?’, rather it is ‘how do we ensure timely, quality delivery for everyone?’

Part of me feels the same way about private health care use and cue-jumping as I do about marijuana use. It’s going to be happen anyways, so let’s regulate and tax the hell out of it. Let’s say a few changes were made to the health care system. There were more health professionals trained and practicing. Private delivery was allowed, but heavily regulated and taxed by government (with revenues going back into the public system). As long as everyone – from the millionaire business-owner to the single parent on income support was receiving timely, effective care, would it be such a calamity?

I recognize this is, and continues to be a controversial issue. It’s going to be an increasingly complex one to deal with as our population ages. I only hope we can have a mature, serious, open conversation about health care. Demonizing people who simply raise the prospect of private delivery is not the way to get there.

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One Response

  1. 1. First off, most health care is already “privately-delivered”. Any physician with an office is a private business (55–60% of physicians). Most hospitals in Canada are run by private corporations (35% of physicians, though there’s overlap since some physicians work in both a hospital and an office). Only a small minority of physicians work exclusively in a public provider (e.g. government-run hospital, academic position). If you’re opposed to private delivery, that ship has sailed.

    Actually, it’s never come to port to stretch the metaphor beyond reason. Physicians were private pre-national health insurance. They’ve pretty much remained so.

    2. What Gary Mar is getting at is private payment rather than private delivery. Even here, we should note that about 30% of healthcare is privately paid (e.g. medications, dental services, vaccines not publicly-funded, cosmetic procedures, etc.). There’s a reason most people buy supplementary health insurance or receive it as an employment benefit—it’s to help cover these expenses.

    Nonetheless, people make a stink whenever someone starts unconventional private hospital (e.g. orthopaedic services in Alberta, the orthopedic-only Cambrie clinic in Vancouver) yet longstanding private hospitals (e.g. those run by the Caritas health group in Edmonton) don’t get a notice.

    3. The area of controversy with private-payment is paying for a publicly-funded health care service. It should be noted that there is no law against this in Canada. It’s regulated in that a physician cannot charge the government for some patients and the patient in other cases (i.e. you have to be a publicly-paid physician or a privately-paid physician). The logic here is that if you a surgeon and your patient and you’re advising surgery, you could tell the patient there’s a 6 month waiting list for the public OR, but you’ll be able to sneak them in next week if they pay privately. That’s seen as inappropriate and so the government restricts it.

    The negative of this policy is that virtually no one wants to become a private-payment only service provider. Most physicians depend on the referral of a primary care physician and since most patients won’t want to pay, they won’t refer to you if you’ll charge the patient. It’s generally just difficult (or at least very risky) for a physician to get by charging every patient and so virtually no one wants to opt-out of being able to bill the government.

    4. The only real policy question is whether physicians should be able to work partly for public-payment and partly for private-payment. If we do this, we need to somehow build firewalls between the two practices to prevent abuse. That’s difficult, but that needs to be the focus of any intelligent discussion.

    – Mustafa Hirji

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