People are too willing to accept the idea that health care’s future will be a tense pull between public versus private systems, says a University of Regina professor.
Greg Marchildon, a former deputy minister in Saskatchewan who also worked on the federal health commission headed by former Saskatchewan premier Roy Romanow, called the private versus public debate “irritating, confusing and misleading.”
He told an international health-care conference Oct. 30 that with all the health demands in the future, Canada should look for a third way.
However, regional health authorities are contracting out services they can’t handle to for-profit companies rather than considering co-operative and non-profit models.
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For example, with the number of seniors expected to increase, there will be more cases of dementia and mental illness, which would be best treated close to the patient’s family.
Marchildon said co-operatives are often not considered because they tend to be small, local agencies. However, he added, sometimes smaller organizations are more nimble and can deliver services quicker than a big corporation or government.
He said there is an opportunity for co-op health-care advocates to make their case in Alberta. The provincial government has scrapped its regional districts in favour of a centralized system. It will be contracting directly with third party agencies to deliver health services. It could choose to set up co-operative bodies as Quebec did, but Marchildon said Alberta is predisposed to work with for-profit groups.
He said the rising cost of health care is another example of the public versus private myth. Health takes 40 to 50 percent of most provincial budgets and is still rising.
The cost of universal services that are free to patients has grown at the rate of inflation for the past four decades, but the real problems are private services and drug costs, which have grown at double the rate of inflation.
University of Sherbrooke researcher Jean-Pierre Girard said politicians aren’t talking about the development of supercentre medical clinics offered by grocery chain Loblaws in Ontario and a pharmaceutical company in Quebec.
In the United States, several health management organizations were originally consumer-owned co-ops that were sold to corporations because of the rising costs of delivering health services, Girard said.
U.S. government expenditure accounts for 45 percent of health services and private agencies account for 55 percent of the costs, while 47 million Americans are not insured for health care.
Girard said in Canada, the government accounts for 70 percent of health spending and the private side is 30 percent.
Per-Olaf Jonsson, head of a lobby group of 30 Swedish health co-ops, said procurement laws at the beginning of the 1990s hindered public health in that country. Patients were allowed to choose their own doctors, and hospitals started delivering community services, creating competition for co-ops. Large multinational corporations also moved in.
Jose Carlos Guisado del Toro, who heads a non-profit health-care company in Spain, said effective use of money is what keeps Spanish health co-ops on top.
“Our cost is 40 percent less than the care provided by the state. Citizens want to be healthy and have low cost care.”
Del Toro said the debate will soon change from public versus private health care to whether it is sustainable.
