Public versus Private healthcare system in Canada!

The debate on public versus private health care in Canada is not new but it has never been so important. Before we dive more into the subject, a few concepts must first be clarified. Privately delivered health care must be distinguished from privately funded health care. Privately delivered health care is already prevalent in Canada. When you walk into your GP's offices, your local non-hospital lab or radiology centre, these centres are privately owned, operate on a for profit basis and thus, their services are privately delivered. Most of these services rendered however are publicly funded i.e. covered by medicare but additional "non essential services" are not.

For example, if you walk into your GP's office, a physical exam will be covered but if you would like to have a vasectomy, you will be billed for the procedure. In contrast, hospitals are government run entities and their services are publicly delivered on a not for profit basis. In fact, Dr. Albert Schumacher, former president of the Canadian Medical Association estimates that 75 per cent of health-care services are delivered privately, but funded publicly. Currently, Canadians have the option to buy supplementary insurance to cover for these non essential services which includes ambulance service, private beds and numerous services and procedures such as cosmetic surgeries, massage therapy, etc. that are not considered essential

Recently, however, we have seen the emergence of privately run centres that offer essential surgical procedures or emergency room services such as Urgent Care Center and the Cambie Surgery Centre in Vancouver. These centres differ in that their services are not only private delivered but also privately funded. At these centers, all services will be billed to the patient and currently Canadians cannot purchase insurance for most of the services offered.

The debate regarding privatization of health care is really one of privately funded health care of essential services. As you can imagine, this debate is heavily emotional and will dictate the direction of the future of the Canadian Health Care system.

There is already a significant component of private care under current system; for example drugs, cosmetic surgeries, dental services etc. Canada in 2006 spent an estimated $142 billion on health care in 2005, or $4,411 per person, according to Health Care in Canada. After taking inflation into account, this amounts to almost three times what was spent in 1975. Of that, just over $98.8 billion was spent by governments delivering public health care. An additional $43.2 billion was spent privately for additional services.

Within our publicly funded system, patients often experience long wait times even for essential services such as emergency room visits, hip or knee replacements or sometimes even radiation treatment for cancer. This is one of the reasons for thriving private surgery clinics like the Cambie Surgery Center (http://www.csc-surgery.com) in Vancouver owned and run by Dr. Brian Day former president of the Canadian Medical Association. Dr. Day along with many feel that there should be more privately run, privately funded centers to alleviate some of the backlog in the public system. On the other hand opponents against privatization will argue that since physicians must choose between the private and public system, if more privately funded centers are opened, this will lead to an exodus of physicians, health care workers and philanthropic funding out of the public system further eroding the public system.

What do you think? How much privatization is good for the Canadian system, to achieve sustainability in the long term?
Looking forward to your comments and votes on our first two poll questions.

We've attached a few articles here if you're interested in reading more about the topic and the debate. We welcome you to send any articles you have for us to post:

New England Journal of Medicine article on Canadian Healthcare
CIHR: Expert Alert, Public versus Private Healthcare debate
CBC news: Public versus Private Healthcare debate

1995 Article from canadian Medical Association Journal

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Chander Sehgal and Michael Tong