Getting to the Heart of the Private Hospital Debate

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For most Canadians our health care system is a point of pride. It distinguishes us from the United States, demonstrating what we like to think of as our kinder, more gentle ways.

Lately you can't turn your head without hearing that our health care system, among other things, is not "competitive" enough in the new global economy. Again we are compared to our neighbours to the south.

The line goes: "Our health care system is too inefficient. It's too costly, and is quickly falling behind in the global race."

With an argument along these lines, the latest, and most direct, hit to our health care system has come from Alberta Premier Ralph Klein.

Klein has introduced legislation to let private, for-profit hospitals into the Alberta health care system. The legislation would allow the Alberta regional health authorities to contract out in-patient medical and surgical procedures requiring overnight stays to for-profit companies, who would perform the surgery at a price to the health authority.

We've heard so much that our health care system is ailing and needs resuscitation that we begin to wonder: "Is this the answer?" "Will the for-profit system be able to solve the problems that surely exist in our current system?" (If you've been in a hospital lately, you know there are problems.) "Will it keep us in the global race?" "And, what about our kinder, more gentle ways?"

Are Private Hospitals Cost Effective?

If the question is: "How can we make our hospitals more cost efficient?" then the answer surely is that the for-profit system, with its focus on the bottom line, is the way to go, right? Wrong.

Getting back to our neighbours to the south, data analyses from all 5,201 acute care hospitals in the US found that for-profit hospitals were 25% more expensive than public not-for-profit facilities, a 1997 article in the New England Journal of Medicine found.

Harvard physicians Wollhandler and Himmelstein showed that 53% of the difference in cost between public and for-profit hospital care was due to higher administrative charges in commercial facilities.

Also, in Canada medicare costs us about 9% of our wealth, while in the US the cost is about 15%.

Problems in Our System

"So, if our system is more cost-efficient, is it at the expense of its patients? What about hospital waiting lists and the quality of our medicine?"

One example: The Consumer's Association of Alberta found that cataract surgery waiting lists in Calgary (where it is contracted out the private clinics) are much longer than those in Edmonton (where 89% is done in the public system).

As far as quality is concerned, the available research points to not-for-profits again as the winner. For example, John Hopkins researchers, investigating all dialysis centres in the US, concluded that patients receiving care at for-profit facilities had a 20% higher death rate and were 26% less likely to be sent for renal transplantation than those attending not-for-profit centres.

That being said, there is a lot of evidence to show that money in our health care system is not being spent appropriately, particularly for women, but it looks like for-profit hospitals won't bring the solutions.

The Global Economy

Our health care system is considered a public good, and not on the global trading stock, but it is falling increasingly under pressure from various trade agreements.

On signing the North American Free Trade Agreement (NAFTA), the federal government did try to shelter health care. But, it protects it only if it is considered a social service carried out for public purposes - and only for policies that are "maintained in force" after January 1, 1994.

"Despite Premier Klein's assertions that this policy can be tried on like a new suit, a future Alberta government [wishing] to terminate the experiment with for-profit care would be faced with a major problem [under NAFTA]," writes Dr. Michael L. Rachlis in his Review of the Alberta Private Hospital Proposal.

The problems under NAFTA don't stop in Alberta, argues Rachlis. A foreign for-profit health care company could charge that the Alberta law had an impact on federal law (the Canadian Health Act) and that the whole country was now open to for-profit hospitals. It would allow a foreign company to sue another province if it tries to block it from entering our marketplace.

A Kinder, More Gentle Country

Canadians know in their hearts that health care is about health and not profit. It's about quality and access, not markets.

When Premier Klein says he intends to protect the public system, and that his privatization scheme is designed to "relieve pressure" on the public system, we know there is something fishy about this coming from someone who has already tried twice to pass bills to allow private hospitals to practice in Alberta.

And although this bill does not out and out contradict the Canadian Health Act, the legal document outlining the rules of health care in Canada, we know that because it is against the spirit of the act, it should be stopped.

What are groups doing?

Groups, like the Canadian Health Coalition and the Canadian Union of Public Employees, are asking federal Health Minister, Allan Rock, to step in and outlaw for-profit hospitals in Canada, starting with penalizing the Alberta provincial government for threatening the integrity of the Canada Health Act.

CUPE www.cupe.ca

Canadian Health Coaltion www.healthcoalition.ca


Former Health Minister Blows the Whistle

Diane Marleau, former health minister, recently came forward with the news that she was sent to the back benches of the Liberal government because she tried to stop private health care from getting a foothold in Canada.

"I was trying to forbid user fees," Marleau told Straight Goods, describing her run-in with Alberta premier Ralph Klein in her effort to stop a private eye clinic in Alberta from charging a "facility fee" of $1,275 per eye.

While Marleau was ready to fine Alberta for this infringement of the Canada Health Act, Prime Minister Jean Chrétien was publicly putting forward his own vision of medicare as a "no frills" plan covering only "major surgery."

"Look at what they did to me," she said, recalling the rumours spread about her competence on Parliament Hill, ending in her being pulled from the health portfolio to the back benches.

Source: The Straight Goods www.straightgoods.com