For-profit won't heal health care

As run in the Toronto Star April 16, 2009

Michael Rachlis

Earlier this year, Dr. Robert Ouellet, president of the Canadian Medical Association, and other CMA elected and administrative officials travelled to the U.K., Denmark, Belgium, the Netherlands and France to study their health-care systems.

Ouellet concludes that the Canadian health-care system performs poorly because our health system is one of the costliest (eighth out of 28 OECD countries) and yet many Canadians have to wait too long for care. Then he selectively culls his European experiences to mould an ideological platform calling for more private sector involvement in Canada's system.

It is true that we can learn a lot from other jurisdictions. The Danish have arguably the best programs and services for the elderly. The U.K. National Health Service has the strongest primary health-care system with nearly 100 per cent of British family doctors' offices equipped with electronic health records.

But Ouellet conveniently ignores that all is not well in Europe. In France, patients commonly pay up to $1,600 for a cataract extraction and up to $6,500 for a hip replacement. In Britain, several academic papers have concluded that building hospitals with public-private partnerships has increased not decreased costs.

However, my main objection to Ouellet's European excursion is that he could have saved a lot of my association's money if he had spent his time in Canada.

He claims that Canadians can only dream of the two-week wait times for hip replacements in France or the same-day doctor appointments in Belgium. But if he had visited Toronto's Holland Orthopedic Centre, he could have seen patients who are rapidly assessed for joint replacements and typically get their surgery within two to four weeks of seeing an orthopedic surgeon.

If he had visited the Saskatoon Community Clinic, he could have seen a patient-run centre that offers same-day doctor appointments. If he had visited the Hamilton mental health program, he could have seen 17 psychiatrists linked to more than 100 family doctors and 80 counsellors providing some of the finest access to specialized care anywhere in the world.

Of course, good health care means more than getting to see a doctor. Toronto's Access Alliance Multicultural Community Health Centre uses peer outreach workers to connect immigrant mothers and children to their new communities and ensure they receive appropriate preventive services.

I agree with Ouellet that we need electronic health records. But his recommendations for private sector involvement are not only irrelevant to the real solutions, they are positively dangerous.

The academic literature is clear. Private insurance costs more than public coverage and it's less equitable. For-profit care tends to be more expensive and of poorer quality than not-for-profit care.

The Reagan era rhetoric endowing the private sector with magic powers has proven as bankrupt as Lehman Brothers. It is gratifying that finally the CMA may also update its medicare views.

Ouellet owns a chain of for-profit imaging clinics and his immediate predecessor, Vancouver orthopedic surgeon Dr. Brian Day, owns the private Cambie Clinic. Both proudly admit to charging patients extra for faster care.

But Dr. Anne Doig, a Saskatoon family physician who will take the chain of CMA office in August, has no anti-medicare axe to grind. And just last month, Ottawa internal medicine specialist Dr. Jeffrey Turnbull won a ballot to become CMA president-elect on a strongly pro-medicare platform.

We don't have to sell our medicare birthright to the private sector to reduce waits or improve quality. Of course, other countries can provide inspiration but we already have most of the solutions right here. Now's the time for some action to implement them.

Dr. Michael Rachlis is a health policy analyst and an associate professor at the University of Toronto.