Mixed private-public system best for Canadian patients

TheStar.com – Opinion – Mixed private-public system best for Canadian patients: Health-care debate should be based on improving treatment not political ideology
September 03, 2008. Dr. Robert Ouellet

When I began my term as Canadian Medical Association president last month, I expected some criticism and knew that not everyone would agree with my views on what needs to be done to improve our health-care system.

I did, however, hope that we could have a rational, fact-based debate on how best to improve patient care. Unfortunately, rhetoric, fear and deliberate misinterpretation are once again being used to beat down any legitimate attempt to go beyond the status-quo.

Yes, I am part-owner of a number of private radiology clinics in Quebec.

Yes, I have a mixed practice (public/private), as do most of my Quebec radiology colleagues.

Yes, I believe there can be a greater role for the private sector in Canada’s health-care system.

This does not mean that I want to see the public health-care system weakened or destroyed. It doesn’t mean that I want to see “American-style, two-tier” health care here in Canada. And it doesn’t mean that I believe money and not malady should determine the quality of care Canadians receive.

In 1987, when I was head of the radiology department at my hospital, I was told it would be at least two years before the hospital could purchase a CT scanner, despite heavy demand.

This was clearly unacceptable and severely compromised patient care, so I joined with some colleagues to buy the equipment and the hospital began referring publicly funded patients to us.

Ten years later in 1997, I opened one of the province’s first private MRI clinics. Again, we served patients from public hospitals – including my own which, by the way, didn’t buy an MRI unit until 2002.

The driving force behind all of these efforts was not profit, nor some ideological attachment to the free market. It was the fact that our patients were not getting the care they needed and wouldn’t be for years. As a result, my colleagues and I stepped in to provide it.

Some of my patients do pay out of their own pockets. I make no apologies for that. In Quebec, MRIs performed outside of hospitals are not publicly covered. However, most residents are reimbursed 80 per cent through private insurance, so the net cost to them is about $130 for an MRI exam.

It’s also a small price to pay to free up space on the public waiting list. While emergency cases are – of course – seen immediately, the average wait for more routine MRI exams can stretch as long as six to nine months. If the 20 MRI clinics currently operating in Quebec weren’t there, can you imagine how long the wait would be?

There is, however, a role for the private sector in our health-care system, because it exists now. Private companies do blood tests paid for by the public purse. Governments, through organizations like Workers’ Compensation, are the private sector’s best customers. And, more than 70 per cent of all Canadians have some form of private insurance – usually through their employer – that covers what medicare does not.

This is the current Canadian reality. It makes little sense to deny it. We need to be open-minded and look to places like Europe for guidance on how best to mesh the public and private. They can work together, and advances in one do not have to come at the expense of the other.

The CMA also believes that our health system has become too focused on administration and not focused enough on providing efficient care. Right now, most of our hospitals get lump sum budgets at the beginning of the year. This sets up a strange paradox where patients are actually a drain on hospital finances and there is no incentive to provide care.

We think that patients should be at the centre of health care in Canada and that funding should be based on efficiency, effectiveness, effort and, above all, results. The current monopoly needs to be broken down and an element of patient-focused competition introduced.

At the same time, we will aggressively defend the need to have a health-care system that is sustainable and fair. A system where all Canadians have universal access to quality health-care services, regardless of their ability to pay.

In conclusion, I have to ask those who say renewal is not needed whether they think it is acceptable that we ranked last in comparison to most European countries when it came to value for money? Is it acceptable that patients are stuck deteriorating while on wait lists? Is it acceptable that 5 million Canadians don’t have access to a family physician?

The CMA doesn’t think it is acceptable and I doubt most other Canadians do either. I think it is time for some bold thinking. I think it’s time to act. I think it’s time to build a health-care system that serves patients and not simply the political views of self-appointed health-care pundits.

Rather than preaching a dogmatic approach to system change, let’s instead take a practical approach that builds on our sound principles of equality and fairness, while ensuring access to health-care services for all Canadians.

Dr. Robert Ouellet is president of the Canadian Medical Association.

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