Healthcare: Private versus private.

As Liberals, I think we need to be careful that we are not just engaging in polemics. In Canada, the debate over delivery of healthcare services must be framed within the five principles of the Canada Health Act

• Public Administration: The plan must be administered on a non-profit basis by a public authority accountable to the provincial government for its financial transactions.
• Comprehensiveness: All medically necessary services must be insured.
• Universality: All residents of the province must have access to insured healthcare services under uniform terms and conditions.
• Portability: Insurance must cover residents who are temporarily absent from the province.
• Accessibility: Insured persons must have reasonable and uniform access to insured health services, free of financial or other barriers.

So where does private delivery of healthcare services fit into this framework? Hospitals and clinics have contracted out certain medically necessary tests, procedures and services for years. Lab work, blood work, diagnostic imaging (MRI/CT scans), radiology, day surgery, haemodialysis, physiotherapy, etc. have all been provided to various degrees on an outsource basis in most provinces. This outsourced private delivery model presents no threat to public healthcare in Canada, as long as insured services are not provided or billed directly to patients. There is also no threat in private providers providing non-insured services such as cosmetic surgery. As long as private providers are willing to live within these constraints, they present no threat to the Canadian healthcare system. The only threat in this private delivery model is to the unionized employees in our public hospitals – and we can let the NDP worry about that.

BTW - I also see no particular threat in hospitals providing enhanced services such as private rooms, lightweight casts, or turbo-charged wheel chairs to patients whom are willing to pay or have extended healthcare insurance, as long as the provisioning of these extended services in no way constrains the provision of universally insured services.

Where the threats to universality start to appear is when you allow private clinics to provide insured services to private patients (either within regular business hours or after hours). This is where the parallel or two-tiered system shows up. In such a system there is a perverse incentive for providers not to provide service to patients in the public system as wait lists enhance the value of their private service.

I am not advocating private delivery but we need to fight the right battles. There is a difference between private delivery of services within a single payer system and private delivery of service in a parallel system.