Privatization is not a quick fix for the health system
TheStar.com – opinion/editorialopinion
Published On Fri Jan 07 2011. Sharon Sholzberg-Gray
The Fraser Institute has recently called for a five-year suspension of the enforcement of the Canada Health Act, claiming that this would permit more “experimentation” with cost sharing and privatization, which would be a solution to access issues and sustainability of the health system. Cost sharing is a euphemism for double-dipping by physicians and user fees that lead to queue-jumping.
Private delivery of health services using public funds is not precluded by the Canada Health Act, so those who think that, contrary to the evidence, private delivery would create savings, cannot claim that the act is a barrier to private delivery. However, most of the experience in Europe and the United States is that private hospitals and clinics engage in cherry-picking while the sickest, most complex patients are in the public or not-for-profit system — or are heavily subsidized by the public purse.
The federal health minister has rightly rejected the Fraser Institute’s request, noting that “we expect the provinces and territories to abide by the act.” However, the federal government does not appear to have the inclination to monitor compliance with the principles of the Canada Health Act as a condition for receiving federal money.
How would suspension of the Canada Health Act help make health-care spending more “sustainable”? Actually, the act requires coverage of medically necessary hospital and physician care only. This represents 42.6 per cent of Canadian health expenditures. The fact is that the problems in the health system are caused primarily by the lack of access to services not covered by the Canada Health Act. Over and over again, the “experts,” including the Ontario auditor general, have noted that the emergency backlog problem and the lack of hospital beds for treatment and surgery are caused by insufficient services provided outside of hospitals, specifically home care and long-term care, which are not Canada Health Act services.
Patients waiting for discharge from Ontario hospitals account for 16 per cent of patient days. The Canada Health Act does not require that these patients receive home care or long-term care funded in whole or in part by the public purse. The barrier is that these patients cannot afford to pay for their own home and long-term care and prescription drugs. So how would suspending the Canada Health Act solve this issue?
What about health expenditures and health system sustainability? Health care represented an average of 39.2 per cent of provincial and territorial program spending in 2009, according to the Canadian Institute for Health Information. However, according to John Wright, CIHI’s CEO, “although health-care spending has been on the rise for the past 10 years, the share of provincial budgets devoted to health care appears to have stabilized overall, though the situation may vary by province.”
This contrasts with the Fraser Institute’s prediction that in six out of 10 provinces, government expenditures on health care are projected to consume 50 per cent of provincial revenues by 2034. Its solution is private payments, co-payments and private insurance options for already covered hospital and physician services. This would mean transferring a larger health expenditure burden to private businesses and other employers that now provide insurance for prescription drugs and other health costs not publicly insured.
The loss of a single-payer system for hospital and physician services and the pressure to cover them privately with duplicate insurance under the guise of quicker access to these services would make businesses less competitive in a difficult economy, at a time when more and more jobs are being transferred overseas.
Everywhere in this country there are best practices and public solutions that can be emulated. Health providers together with the support of forward-looking government policies — yes, there are some — are finding ways to solve access and sustainability issues. The problem is that some people are looking for a simple quick fix (more privatization, get rid of the Canada Health Act) when there are multiple solutions.
The list is long and some examples are: better access to home care; continuing care services and prescription drugs; a wait times approach that addresses both quantity and appropriateness (make sure that people receive physiotherapy services rather than surgery as required); an emphasis on quality; a focus on chronic care management and keeping people well thus obviating the need for more and more interventions; integrated and patient-centred health services; an electronic health record as an enabling tool, and an evidence-based approach to everything we do.
It is not enough merely to call for more private expenditures. We need to find ways to control health costs and get better value for money instead of looking for ways to shift the costs from the wealthy to the sick. So let’s get on with it.
Sharon Sholzberg-Gray is a health-policy adviser and served for 10 years as CEO of the Canadian Healthcare Association.
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