More on the Castonguay report

Re: Toronto Star: Quebec health report rings alarm for universal care, Feb. 25, A14.

A clinical review may reveal that the error that happened at the Rockland MD clinic could have happened anywhere, but the growth of commercialized health care should be a concern for all Canadians, not just Quebeckers. Research by McMaster University's P.J. Devereaux and colleagues shows not for profit care is safer, less expensive and fairer than commercialized care Review comparing mortality rates of private for-profit and private not-for-profit hospitals and Comparison of mortality between private for-profit and private not-for-profit hemodialysis centers. If commercialized care continues its spread across Canada, fuelled by the repeated use of alarmist rhetoric and discredited research – such as Canada ranks 30th in the world in health care - ( See "Why Did the World Health Organization Rate Canada's Health System as 30th?") - Canadians will soon find that the promised benefits evaporate into the thin air on which they are based.

In research analysis, we are trained to look for the inherent biases in a study before we accept the findings. When a study finds, for example, that "butter is good for you", but is sponsored by the Dairy Association, we have to ask ourselves whether there is some self-interest in the conclusion. When a report of drug industry-sponsored research says that a drug shows a favorable outcome, we must question the safety and efficacy of the drug. When a proponent of private care, physician or not, quotes statistics that show Canada ranks at the bottom of the pack in health care, we know instinctively that something isn't right with this figure, and we need to make serious enquiries as to why it is being put forth as an argument for private care. When the head of a health care commission is a trained actuary, a former President of the Canadian Institute of Actuaries, and a longtime proponent of private health insurance coverage, increased private delivery of care, physicians working simultaneously in public and private systems, and user fees, we must indeed ask ourselves who would benefit from the proposals – the most likely answer is the investors in insurance companies, including those poised to move into Canada from the U.S.

Canadians can take comfort from the fact that, despite our problems, Canada ranks sixth in the world in preventing death from medically treatable disease Canadian health care better and cheaper than U.S., says research. Nevertheless there is much that needs improving in Canadian health care. The good news is that this is happening in the efforts to reduced shortages in the health professions and successful pilot projects to reduce waiting lists across the country. (See "Why wait?) This is where our focus should be.

Nan Okun, MD
Alan Katz, MD
Claudette Chase, MD, CCFP
CDM-MCRP Board Members

The Castonguay Report

The proposal by the Castonguay Report in Québec that doctors should be allowed to work in the public and private system - and private insurance companies should cover services currently in the public health program – is clearly an attempt to create a private medical market in Quebec. The beneficiaries are not likely to be patients, unless they are rich. A parallel private system may provide faster care to those with the ability to pay, but extensive experience in other countries makes clear that it seriously compromises access for those waiting for care in the public system, and contradicts one of the features of public healthcare that Canadians cherish, namely that we should receive care based on need, not on our ability to pay.

And if Claude Castonguay thinks the current Canadian system is rigid, he should try talking to physicians who have worked in the United States where each insurance company controls what services they pay for. I worked as a physician in the US for over 20 years and saw first hand the inequality, inefficiency and high cost of profit driven health care in that country. Canadians should avoid at all costs introducing private for-profit health care delivery.

There is abundant evidence that private for-profit care is more expensive and strong evidence that, at least for hospitals and dialysis facilities, for- profit care leads to poorer outcomes. Review comparing mortality rates of private for-profit and private not-for-profit hospitals and Comparison of mortality between private for-profit and private not-for-profit hemodialysis centers Thus we pay more, whether through taxes or premiums, and get less. It has also been shown that user fees meant to deter "unnecessary visits" will also deter necessary ones.User fees will stop waste.. The rich won't have too worry about them but middle class Quebeckers will.

It's time for politicians and their consultants and special interest groups to put ideology aside and pay attention to the evidence, as both the Romanow Commission and the Kirby Senate Commission did. They concluded that public funding and delivery of health care is both more efficient and more effective than private for-profit delivery and that solutions to the current problems in the public system should be addressed in the public sector. Indeed, examples such as the Alberta Hip and Knee Replacement Pilot Project have shown them to be correct.

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