Too much focus on competition

Before people simply blow a gasket and reject out of hand any suggestion that there is space in Canada for private health care delivery of any kind, we should take a close look at what Canadian doctors voted to ask for, at their national convention in Saskatoon last week.

Before people simply blow a gasket and reject out of hand any suggestion that there is space in Canada for private health care delivery of any kind, we should take a close look at what Canadian doctors voted to ask for, at their national convention in Saskatoon last week.

The Canadian Medical Association is planning a blueprint for reforms to our national health care system, and their meeting in Saskatoon voted 85 per cent to urge all governments to allow competition for public health care dollars.

Why they centred their campaign around the notion of competition is a bit of a puzzle, because the basic principles supporting the Canadian model of health care delivery already allow doctors to build their own health clinics, or operate diagnostic centres or labs to conduct tests. Eye surgery is already offered through private clinics, as is midwifery services.

The test for the Canadian model is that these services bill the provincial health-care system, and not the patient, for the treatments given.

We already have that in the system, and as long as the basic principles of public health care are upheld, there’s nothing to prevent private investors from building more clinics, more labs, or more diagnostic imaging centres.

So why the CMA’s discussion centred around the notion of encouraging competition in the health care system is a mystery.

As far as the patients can tell, there’s nothing to compete for. In fact, any competition in the Canadian health system is among patients trying to find a family doctor at all, or to shorten their wait times for treatment.

Not too many people sitting in emergency wards ever complain about doctors bothering them to offer service.

Sick people are a captive market, so how would competition help ease their lot?

What the doctors say they want to compete for is dollars from the central system. We already know that provincial health care budgets are becoming a more finite resource, so we’d like to know how competing for dollars inside that envelope will help patients.

We’ll also need a clearer explanation of what prevents doctors from seeing more patients or doing more surgeries, that encouraging competition would fix.

One notion that springs to mind is specialization. If the CMA’s blueprint calls for special treatment centres dealing solely with joint replacements at one venue, cardiac treatments in another and cancer at another, and efficiencies in service can be gained this way, there’s nothing much to object to. As long as all payments are made out of the public system, and nobody is turned away or delayed for lack of ability to pay for “extras” (whatever they might be), that sounds like a good plan.

What makes Canadians blow a gasket is talk about allowing extra-billing, queue-jumping or separate care delivery modes based on ability to pay.

If this is what the CMA is asking for, they should say so, using those words.

If the CMA is interpreting “competition” to mean lowering salaries for nurses, lab techs or therapists, so there’s more of the pie for them, they should also say so, using those words.

If the CMA is encouraging governments to de-list services from the public system, so that doctors could open private clinics for more kinds of services, Canadians would like to hear that, too.

Other than these things, what’s a doctor to compete for? There’s already more work than our doctors can do in a timely fashion.

Socialized medicine never disallowed good pay for health care expertise, nor did it ban investors from making a profit within the system.

What it does mean is that everyone is covered for care, and that the cost is covered by the government purse.

How the notion of competition will improve that needs some explanation.

Greg Neiman is an Advocate editor.

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