Thursday, February 21, 2008

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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