Patients should be at the centre of the health care system

Re: Healing the system, Vancouver Province, Wed 02 Apr 2008, Page: A4

Dr. Day has it right; patients should be at the centre of the health care system. Unfortunately his prescription for getting them there - forcing competition between hospitals and private clinics - will put profit at the centre, resulting in unhealthy outcomes for most Canadians.

Patient-centred care requires collaboration, not competition. The British Medical Association has expressed serious concerns about the effect of competitive practices, as have doctors south of the border, a majority of whom now want a collaborative style national health insurance program[Annals of Internal Medicine]. The major side effect of competition in countries that allow private for profit care is that the benefits generally go to private hospitals, insurance companies, specialists and wealthy patients. Even Dr. Day's own organization the Canadian Medical Association has said private insurance for medically necessary physician and hospital services does not improve access to publicly insured services, does not lower costs or improve quality of care, can increase wait times for those who are not privately insured, and could exacerbate human resource shortages in the public system.

No doctor wants to see their patient languish on a waiting list. But reducing wait lists does not require the profit motive. It's being done across the country through queue management, improved primary care access and collaborative care models, resulting in dramatic drops in waits in such key areas as hip and knee replacements, cataracts and cancer care. We need a lot more of this.

However, it's also important to remember, that far from being at the bottom of the pack in providing health care – as Dr. Day often suggests - a recent study in Health Affairs by researchers at the London School of Hygiene and Tropical Medicine rated Canada sixth in the world in preventing death from treatable conditions, an excellent value for money.

Danielle Martin and Randall White
Canadian Doctors for Medicare