Two-tier, single-tier

By Editorial

What constitutes an acceptable balance between public and private medical services? Alberta Premier Ralph Klein thinks he has the answer in contracting public services to private practitioners. Apparently, though, he claims a tier-two system is not in our future. Right…

The Canada Health Act guarantees universality of "medically necessary" services based on need and without financial barrier. Does Klein’s main point regarding health care measure up to this standard?

His exact idea is that health authorities will be allowed to contract with privately-operated facilities for surgical services only if it will improve access, efficiency or reduce waiting lists. So basically, the government wants to pay private clinics for our health care using public money. Gee, this sounds like public health care.

The worst thing about these types of parallel services is that they specifically target technology and high volume/short-stay surgery. This includes: Magnetic Resonance Imaging, ultrasound scanning, arthroscopic and cataract surgery, physiotherapy, and abortion. All of these are available through private clinics and are high-demand services. In regards to a two-tier system, there remains the question of the slippery slope because private entrepreneurs may exploit the services able to generate the maximum profit and leave more difficult cases for the public system to deal with.

Klein may not advocate a two-tier system, but paying off the private sector for high-demand services leaves the public system with the leftover cases, some of which may not be as profitable. And let’s face it, if you can make your money off the government in private practice, why stay with the dregs of the public system?

Enter the problem of quality doctors high-tailing it into the private sector of medicine. Consider that these doctors are educated in government-funded institutions and trained in publicly-funded hospitals. In a maneuver resembling the brain drain to the us, we might just set ourselves up for a lateral drain within the country.

Currently, most jurisdictions allow physicians to choose either practice in the public or private sphere, but not both. Klein’s idea allows doctors to now participate in both sectors because they can solicit paying customers as well as contracts from the government. What is public health care again? This sounds like a happy compromise for everyone, but given the above problems there is no doubt public health will erode.

In Klein’s proposed system, patients will still wait for treatments not provided for under private contracts. They may also face a system depleted of its best practitioners all for the same cost they pay now under Alberta’s Health Insurance Plan.

As well, there remains the irony of paying private contractors with public money. The public system is in place to provide patients with the necessary medical services. So maybe it isn’t a two-tier system Klein wants, but the new system will still be rife with bureaucracy, inefficiency and unfair access. While this may not technically contravene the Canada Health Act, it does offend Canadian society’s vision of public health care.