Private Healthcare delivery in Canada

I hope the title of this post does not get me tarred and feathered in public, but this issue is an elephant in the room for many people. I finished reading an article on this very topic, and thought I would open up debate.  According to the article, New Brunswick Health Minister Michael Murphy continues to consider legislation to set the stage for private health clinics. I have seen the same topic come up in BC, Quebec and other jurisdictions.

Note: For the purposes of clarity on the remainder of this post, I am explicitly excluding the approximately 30% of healthcare services already delivered by private entities in Canada such as dental work, some drugs, etc.

I know that considering privatization of public healthcare services is considered blasphemy by the Canadian public, but is it time to reconsider? We see other Western nations delivering healthcare services with a hybrid private and public model. Just look at the health outcomes to cost indicators for hybrid  jurisdictions such as New Zealand…they are better than Canada.

My questions for Mike or anyone else is:

1) Should Canada adopt a larger hybrid model (> the current 30% private) of private or public? What are the reasons for and against?

2) How much (and which services) should be private? Why?

3) How would a hybrid model impact on healthcare IT, or would it?


One response to “Private Healthcare delivery in Canada

  1. I am working with a few others to organize a consumer eHealth conference in the fall. One of the observations that the group made about Canada is that we have a relatively unique health environment based on the following combination of factors:

    – Publicly funded (not that unusual but does distinguish Canada from the US)

    – Federated governance (many other countries have a centralized model for healthcare delivery)

    – No parallel private healthcare system

    We believe that these factors will influence consumer eHealth evolution and may impact how models developing in other countries are deployed in Canada.

    I have often suggested that the reason that we don’t have a large, active private system in Canada is that the US border is very close to where the majority of Canadians live. Those Canadians wishing to pay for healthcare services (either to get them faster or to get access to services not readily available in Canada) can always hop across the border to obtain them. Hence, there hasn’t been the same political pressure to allow private healthcare has may exist in other countries. Thoughts?

    Mark, as you and both know from our market research work together, public healthcare delivery is a complex mix that includes:

    – who pays (mostly public in Canada except for dental, eyecare, and drugs)

    – who delivers (many physicians are actually contractors who get paid on a fee for service basis, not employees of the state or a hospital)

    – who owns (most hospitals are publicly owned in some form or another while most physician offices are privately owned)

    Senator’s Keon (founder of the Ottawa Heart Institute) and Kirby wrote a paper several years ago proposing privately delivered, publicly funded healthcare. Their basic argument is that if a private company can deliver care profitability and accept provincial health insurance as payment then they should be allowed to do so. Both senators stated that private healthcare delivery is accepable as long as universality (anyone who needs care can get it) is maintained through public funding.


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