Canada's already fragile health-care system is at a pivotal moment. An increasing number of people are concerned about lengthy wait times for care and, frankly, about access to any care at all. Longstanding systemic factors have created the perfect health-care storm: a shortage of health care providers, increased demand from a growing and aging population, significant administrative burden on physicians, and continued pressure on hospital capacity with limited community-based options for care.
There has never been a more important moment to reflect on the future of our health-care system. The public-private health-care balance in Canada is an essential part of that discussion. Across the country we have seen the emergence of private health care alternatives attempting to fill gaps. In some private models, services are funded by government. In others, fees are charged directly to patients. Many Canadians who desperately need access to care are turning to private providers because the public system cannot address their health issues in a timely manner. The truth is that the status quo is no longer sustainable, and we need to reimagine how we deliver health care services now and into the coming years.
Over the past year, the Canadian Medical Association (CMA) led a national dialogue on the balance of public and private health care across the country. To inform the CMA’s updated policy on the interface of public and private health care in Canada, we engaged patients, physicians, health professionals and the wider public. We focused on the health care system that they want, grounded in a shared understanding of the system we already have and the key challenges of access, equity, quality, accountability, and system capacity.
We heard from more than 10,000 people across the country through town halls, surveys, and patient- and physician-focused dialogues. While perspectives varied on how to manage the many issues challenging our health system, a strong theme emerged from the discussions: public, universal health care remains a source of immense pride for Canadians.
We heard that providers and patients are aligned in their desire to create a health system that is accessible, equitable, comprehensive, transparent, and accountable. We heard shared fears that expanding private health care would divert resources from the public system, deepen preexisting inequities, decrease comprehensiveness of care, and leave those unable to pay for services at an even greater disadvantage.
We also heard that most Canadians do not have a good understanding of the current and historical mix of public and private operators in our health system. For example, most hospitals in Canada are either publicly funded or private not-for-profit organizations. Long term care homes are a mixture of public, private not-for-profit and for-profit organizations. Local public health units are typically run by the public sector, and most family physician offices are publicly funded but privately operated.
In addition to these national conversations, the CMA completed an environmental scan of health systems around the world and an extensive review of health funding models. While the evidence from other countries and from research was critical to informing our draft policy, it became clear that there is a lack of research on private and public health care in the Canadian context.
This year-long process led the CMA to create a draft policy that addresses the current reality of private care in Canada by proposing guard rails to safeguard universal access to health care. It is a draft policy for a reason: nothing is set in stone. In a unique process, the CMA is offering the draft policy for early consultation with all stakeholders to ensure we are accurately reflecting what we heard in our consultations and gathering more information and perspectives. We hope to have open, honest dialogue about the reality of our current health system, how to balance public and private models, and the potential implications of corporate influence in health care.
Following the consultation process, the CMA will finalize its policy and use it to advocate to federal, provincial and territorial governments as we continue to advance solutions to improve the health system. There must be transparency and accountability, regardless of whether a service is provided by a public or private provider. Crucially, we must ensure that no patient is left behind. The health system must provide timely, equitable care for all - regardless of one’s ability to pay for service.
Physicians feel a strong professional responsibility to ensure that Canadians have access to a well-trained health care workforce today and in the future. We want those who are following in our footsteps to be empowered to deliver quality care.
Despite the long road still ahead to rebuild our health-care system, for the first time in a long time, we are hopeful for the future. We are in a position where we can comfortably have these uncomfortable discussions. This is where change happens.
Dr. Joss Reimer
Dr. Kathleen Ross
Presidents, Canadian Medical Association
This commentary was initially published in The Hill Times