Raisa Deber's article "Public and Private Places in Canadian Healthcare" (Hospital Quarterly, vol. 1 no. 2, Winter 1997/98) has a great deal of appeal to those who are of the view that all we need to fix our healthcare system is more government resources. With respect, I believe that this is no longer a tenable proposition. Advances across the broad spectrum of healthcare from pharmaceuticals to surgical procedures, coupled with the increased healthcare demands and expectations of consumers, make it virtually impossible for government alone to maintain the level of care which Canadians have come to expect.

The Canadian expectation or, as Prof. Deber describes it, Medicare's contract with the Canadian public, is primarily and fundamentally for free and equal access for all Canadians to basic health services. However, even under our current regime this does not include all health services, and the public has come to accept that certain services are not without a cost, either in terms of delayed treatment or expense or both. Our government's spending on healthcare is one of the highest in the world, yet the definition and extent of insured health services seems to be eroding.

In the face of the many challenges to our healthcare system, the role of government as a provider of services must be examined. Canadians are entitled to question whether the government should have the exclusive right to provide those services and at what cost. Perhaps then we can better understand the role which the private sector can and ought to play in this matter. For instance, if we accept that government spending on healthcare should not increase significantly over the next decade or more (either as a percentage of GDP or as an added tax burden on Canadians), then, as many learned authors have suggested, we must insist upon better value through the restructuring and re-engineering of healthcare delivery. But if, as I suspect, all the re-engineering under the sun will not provide new sources of capital or significant increases in funding, then we must be prepared to look at alternative structures and sources of funding if we are to maintain our high quality of healthcare.

With the greatest respect to Prof. Deber, the problem with healthcare is not simply one of allocation of funds. Too much money has already been taken out of the system or will be required in the future in order to keep pace with medical and technological demands. While I am willing to devote a significant amount of my earnings and time to the health of the population of Canada, I have difficulty entertaining the notion that my taxes should consistently rise to meet this requirement. I believe the public accepts that our system of healthcare is worth protecting, but not without an accounting for its cost and some sensible ways of measuring results as well as allocating our resources.

The fears which Prof. Deber expresses about the private sector are, in my view, exaggerated and unjustified. Unfortunately for its critics, no system has yet to be found that can rival free-market enterprise for creating innovative products and services at competitive prices while maintaining cost efficiency and quality assurances. The role of government in overseeing quality and service should be to encourage competition which leads to innovation.

In my role as a hospital trustee for the past five years, I have witnessed miraculous achievements by people devoted to their calling, whether it is in nursing, administration, medicine or community care. Few, if any, of these achievements had anything to do with the "bottom line," or profit motive. The real challenge for us all is to find new ways of partnering with our communities - corporate and otherwise - to rejuvenate our healthcare system, while preserving its values and encouraging the miracle workers within it.

Comments

Be the first to comment on this!