“The people who are espousing the parallel system are seeing themselves as innovative, creative thinkers. The unfortunate part is that the evidence doesn’t support what they are proposing,” said Dr. Claudette Chase, former president of the Ontario College of Family Physicians and a member of the board of Canadian Doctors for Medicare. She works mostly with native patients in Northern Ontario

Chase was reacting to proposals from newly elected Canadian Medical Association president Dr. Brian Day that Canada adopt a pay-for-performance formula for funding hospitals similar to Great Britain’s. This would allow privately owned clinics and hospitals to compete with public hospitals for government dollars. Funding would follow patients, rather than being awarded in blocs to public hospitals, and patients would be free to choose which hospital, private or public, they wish to perform their surgery or take charge of their therapy.

{sidebar id=2}Day claims the parallel private system in England has taken pressure off public National Health Service hospitals and eliminated wait times in most cases. Meanwhile, Canada refuses to fund private hospitals for fear of an Americanized, two-tier system.

British health policy researcher Sally Ruane of the University of Leicester told The Catholic Register wait time reductions in England over the last three years have more to do with infusions of cash into the NHS than corporately owned for-profit clinics.

“Overwhelmingly the greater part of the reduction in waiting lists has been due to extra capacity within the NHS as a result of funding increases and waiting list initiatives and targets,” Ruane wrote in an e-mail.

Ruane is a member of Keep Our NHS Public who gave talks about social justice and health policy to her parish last year during Lent.

As a practical matter of best value for public spending on health care, the introduction of private clinics, many of them owned by American corporations, has led to more spending on advertising and marketing, cherry picking by private clinics happy to take on easy cases and leave the complications to the NHS, and a continuing instability in funding for public hospitals, Ruane said. She also has doubts about the values embedded in a market-driven system.

“The danger with a move towards the market and individualization is that they could, in fact, import the values of consumerism (wants, entitlement based on ability to afford rather than need, profit above service) and displace the traditional values of the public sector,” she wrote. “This sort of trend is difficult to capture and measure, but is no less real for that. Potentially, this undermines the principle of solidarity.”

The question of how hospitals are funded is a bioethical question for Catholics and for secular bioethicists, said Canadian Catholic Bioethics Institute researcher Bridget Campion.

“We try to take an integrated approach to our lives and social justice is a part of that,” she said.

Campion believes any system which favours the ability to pay over need jeopardizes the tradition of Catholic health care in Canada — a tradition which includes the Sisters of St. Joseph establishing the first affordable health insurance in the mining camps of British Columbia and establishing St. Michael’s Hospital in Toronto which treated anyone who came to its doors. She is also wary of the technology-driven “health care industry.”

“The idea that we are regarding health care as an industry and working on an industrialized model of health care — when that happens you say, ‘What exactly is the product? How do people fit into this?’ ”

Like Ruane, Campion believes solidarity is threatened by the attempt to solve problems in health care with market mechanisms.

“As Catholics we get to witness to a different bottom line. What we look towards is Christ’s healing ministry,” she said.

Day argues that as long as the present system doesn’t work it does nothing for social justice or solidarity.

“Our system was built to meet the needs of the underprivileged. It is now failing both them and everyone else,” he said in his inaugural address to the CMA Aug. 22. “Because it has not adapted to the times. The greatest deficiencies are in the poorest regions of our nation, especially aboriginal communities. Our health system has been ranked 30th by the World Health Organization. If a hockey team were one of the most expensive in the league, but ranked 30th, would we not hold the owners and managers responsible?”

Day wants to rewrite the Canada Health Act to allow for market mechanisms in funding.

From her vantage point at Sioux Lookout’s Meno Ya Win Health Centre, Chase can’t see private delivery doing as much for wait times as targeted public policy and public investment.

“Change is inevitable. We know that,” she said. “But we would rather that the changes that happen be based on the really important key principle of the Canada Health Act, and that they be based on the evidence,” she said.

In England a 2002 study by University of Bristol economists Simon Burgess and Katherine Green found that “the relationship between competition and quality of care appears to be negative. Greater competition is associated with higher death rates.” Their results were published in the Journal of Public Economics in July, 2004.

Chase points out that the CMA’s own studies, including a comparison of Canadian and American health outcomes in the Vol. 1, No. 1 2007 issue of the online journal Open Medicine, consistently show market-based medicine is more expensive and less effective. The review of 38 studies comparing U.S. and Canadian health outcomes concluded Canadians are getting value for their tax dollars.

“Canadian health care has many well-publicized limitations,” said the study. “Nevertheless, it produces health benefits similar, or perhaps superior, to those of the U.S. health system, but at a much lower cost.”

On one thing, Chase and Day see eye-to-eye. The wait times problem can’t be solved without more doctors, nurses, nurse-practitioners and other health care professionals. Canada’s 17 medical schools aren’t pumping out enough doctors. Canada ranked second among developed countries in doctors per capita in 1970. In 2007 we are 26th. Day used those statistics in his inauguration speech.

“It just seems ludicrous to me to suggest that having a parallel private system, that people with private insurance could go to, would decrease wait times,” said Chase.

Private clinics offering better pay or working conditions will have to get their doctors from somewhere, and the somewhere will be public hospitals. Moving the doctors from the public to the private system won’t reduce the number of patients, said Chase.

The advantage of a public system is that we’re all in the same boat — doctors and patients, rich and poor, said Campion.

“It is how we are connected one to another. It is a striving for well being,” she said. “We realize our interconnectedness.”