Privatization of Health Care Part 3: Final Thoughts

In the last half decade or so, there have been a few noteworthy studies on how to “fix” Canada’s health care system. I will briefly discuss a few aspects from each that I feel are significant.

• The Fyke Report commissioned by Roy Romanow called for…
• Greater emphasis on quality of services rather than quantity of services.
• Payment of physicians on a salary or contract basis and not on a
  fee-for-service basis.
• Amalgamation of 32 health districts into 11.
• The creation of a 24-hour 7-day-a-week health care advice phone line.
• The creation of an independent quality council.
• Hospital services to be delivered through a smaller number of facilities;
  convert smaller rural hospitals to “health care centers.”
• Establishment of electronic health records.
• Expanding services covered by public funding in the longer term.

• The Mazankowski Report, commissioned by Ralph Klein called for…
• A blending of public, private, and non-profit funding and delivery.
• A reduction in the amount of services covered by Medicare; services to be dropped would be decided by an expert panel.
• A 90 day wait list guarantee for certain services.
• Establishment of electronic health records.
• Expansion of private delivery; however physicians would be required to work a certain amount of time in the public system.

• The Senate Report headed by Senator Michael Kirby called for…
• A new dedicated tax that would raise $5 billion per year for various health programs.
• Government funding of out-of-province or out-of-country treatment if the patient can not receive timely local care.
• Capping of out of pocket drug expenses at 3% of family income.

• The Romanow Report commissioned by Jean Chrétien called for…
• An immediate $6.5 billion cash infusion from the federal government.
• Guaranteed minimum funding amounts that would increase with inflation and the cost of advancing technology/drugs.
• Increased transfers to provinces to expand drug coverage.
• Revision of the Canada Health Act to limit the private sector.

What has resulted?

• Since the Fyke report in 2001, the government of Saskatchewan has…
• Amalgamated the previously 33 health districts into 12.
• Created a Health Quality Council whose function is to evaluate the performance of our health system and make recommendations.
• Created HealthLine, a 24 hour information and advice line where citizens can speak to a registered nurse.

• Since the Mazankowski report in 2002, the government of Alberta has…
• Become the first/only province to implement province-wide electronic health records.
• Allowed private clinics to offer publicly funded services.

• In September of 2004, at a first ministers meeting under Paul Martin, the federal government and provinces reached a deal worth about $41 billion in health care dollars over 10 years. The deal included…
• $3.5 billion over two years for the provinces and territories.
• Guaranteeing a 6% increase in transfers per year.
• $4.5 billion over six years to reduce wait times.
• The development of a national wait times strategy.
• Creating a national home care program.
• Staying true to the Canada Health Act.
  

My Thoughts:
The amount of variance in the four reports (which were all commissioned around the same time, and were essentially supposed to do the same thing) is evidence of the complexity of the situation and the task at hand. It is interesting that the two federal reports both recommended immediate cash infusion and even came up with a similar figure ($5B vs. $6.5B). What’s more surprising is that their recommendations were implemented and even exceeded in certain regards, as the federal government and provinces agreed on $41B over 10 years in health related transfers. Although the two provincial reports both agreed on electronic health records, they seemed to disagree fundamentally on the way health care should be delivered. Mazankowski sought an increased private role while Fyke recommended an increase in publicly provided and funded services over the long term. This difference might be explained by the unique situations in each of the provinces at the time of the reports. Alberta was in the middle of a massive population boom, and the stresses that were felt across the nation, were becoming dire in Alberta, and especially Calgary. Now that Saskatchewan’s economic forecast is looking brighter, it will be interesting to see how our health care system responds over the next decade or so. If Saskatchewan’s population does boom, will we be forced to adopt a stronger private role?

The major challenge right now is to increase the quantity of services that are being provided in a given time so as to bring wait times down to a reasonable level. My position is that maintaining public funding of medical services is absolutely essential if we want to maintain a just and free democratic society where citizens are equal and life is a fundamental right. I have no particular opposition against the private delivery of some or all medical services, provided there are safeguards or economic incentives to ensure equal treatment for all citizens, regardless of the complexity or costliness of their illness. While increasing efficiency is central to reducing wait times, quality must always be maintained at the highest standards – and herein lays our challenge. Electronic medical records and information technology will undoubtedly help improve the efficiency of our health care system – for example couriering an x-ray or a medical record between doctor’s offices seems atrociously old-fashioned in this age of digital files and email (not to mention bad for the environment). Electronic records in the future will also play an important role in public health, as incidence of disease, foodborne illness outbreaks, and population health indicators can be measured and analyzed with the click of a button.

I hope in my lifetime to see (and be part of) real solutions to the problems that are plaguing our health care system. If and when some of the current crises are solved (or at least more effectively managed), the next step I (and Fyke) would like to see is the expansion of services which are publicly covered. Ambulance rides, dental treatment, optometric procedures and prescription drug coverage are all things that I believe should be one hundred percent publicly covered in the future.

Sources:
Alberta Health: Private health care clinics
Alberta NetCare
Saskatchewan HealthLine
CBC News InDepth: Health care