PRIVATE HC REALITY

National Post - 2006-02-16  
Editorial: Another Premier faces health care reality

The province of Quebec has its private health clinics - more than 50 in all,  more than in the rest of the country combined. And Alberta has promised  legislation this spring that will permit the construction of private  hospitals and allow doctors to work simultaneously in both the public and  private systems. Now British Columbia seems poised to join the trend toward  private experimentation with health service delivery. This means three of  the country's four largest provinces, containing roughly half the nation's  population, will soon introduce some form of private care. Ontario remains  the lone big province adamantly committed to the current government-monopoly  system.  

In Tuesday's Throne Speech in Victoria, the government of Premier Gordon  Campbell asked rhetorically, "Does it really matter to patients where or how  they obtain their surgical treatment if it is paid for with public funds?"  The government then laid out its intention to allow a European-style blended  health care system in which government still pays for everyone's essential  treatments, but those treatments may be delivered by a private hospital or  clinic. British Columbia's plan is as yet short on specifics. Alberta's,  too. It may be that neither, when formally unveiled, will amount to anything  more than a rearranging of the deck chairs on medicare's sinking ship.  Still, we can hope.  

This coming month, Mr. Campbell and B.C. Health Minister George Abbott will  visit Sweden, Norway, France and the United Kingdom "to learn first-hand how  those jurisdictions are acting to transform their health care systems." What  they will find are public-private systems in various states of development  implementing reforms with varying degrees of success. Sweden, for instance,  privatized nearly all health care delivery in its capital, Stockholm, three  years ago, with dramatic results. While the central government still pays  for almost all procedures, as before, most patients are now treated by  companies. Even the largest hospitals have been privatized. The result has  been sharply reduced wait times - on the order of 40% for most critical  treatments. Even health care unions that opposed the move have had a change  of heart. Demand for nurses and other health care workers has gone up so  much since privatization that wages have increased 12% to 15%, too.  

In France, Messrs. Campbell and Abbott will find private surgical clinics  operating next door to public ones, with both accessible to average  patients. The competition forces faster treatment and ensures public  hospitals keep up with technological improvements in diagnostic equipment.  The situation is similar in Norway where patients wanting even faster care  can buy private insurance or pay their physicians directly.  

Only in Britain may the B.C. politicians find a blended system still  struggling to find the right public-private mix. Of the four nations named,  the OECD rates only Great Britain as having worse, less timely care than our  own.  

What the pair are likely to find is what the OECD, the Alberta government  and a host of think tanks have all discovered before: Systems in which 10%  to 15% of patients opt for private insurance options are still able to  successfully maintain adequate "free" care for the rest of the population.  In some cases, the parallel private system even drains off enough demand  that service for those who remain in the public system improves.  

Not only does all this leave Dalton McGuinty, the Ontario Premier, and his  Health Minister, George Smitherman, the odd men out, they will be further  excluded by the fact they can no longer go crying to Ottawa to make  privatization experiments stop. Whereas Ujjal Dosanjh and other previous  Liberal health ministers could be counted on for a predictable tirade  against such experimentation - and for a threat or two about transfer  payment cut offs - new Conservative Health Minister, Tony Clement, himself a  former Ontario health minister, is an advocate of increased innovation in  care and is likely to give the provinces a lot of leeway. Given that the  vainglorious Mr. Smitherman once threatened to lay himself down in front of  American mobile MRI labs, should they try to enter his province, perhaps he  should now pledge to throw himself in front of Messrs. Campbell's and  Abbott's jet to keep it from flying off to investigate other health systems.  

In Tuesday's Throne Speech, Lieutenant-Governor Iano Campagnolo said, "In  Canada we have known for many years that the escalation in health care costs  is not sustainable. The question for all British Columbians is this: 'Are we  prepared to change to face up to that fact?'" Canadians, and particularly  the resistant Ontario government, should be asked the same thing.