Last Updated: Friday - 09/24/2010
Week of March 6, 2000
Repair the public health system
Private hospitals promise only an array of new problems
By BISHOP FRED HENRY
Most Canadians believe health care is not just another commodity to be sold for profit, like a loaf of bread or a new pair of shoes. Even in a cynical age when respect for authority in religion and politics has been eroded by a steady stream of scandals and revelations of mendacity, the doctor-patient relationship is held sacred by millions of the sick and those who minister to their bodily and mental ailments.
There is a similar investiture of trust in nurses, physician assistants, and social workers, who labour in the fields of health care alongside physicians and are just as important to patients, although less well compensated than physicians.
It is a fact that until recently, money has not been the chief goal for these health workers nor for the hospitals where their most complex work takes place. Although there are a few arguable exceptions, physicians and hospital administrators have been compensated fairly and even generously by society because society values health care for its members as an important goal and as a form of social justice.
Furthermore, most of us are also convinced that health care is a fundamental human right; that medicine and nursing must not be diverted from their primary tasks - the relief of suffering, the prevention and treatment of illness, and the promotion of health; and that potential financial incentives that reward overcare or undercare weakening doctor-patient and nurse-patient bonds should be prohibited.
Under the Canada Health Act, medically necessary services offered in hospitals and in doctors' offices are publicly administered and funded. According to this principle, no Canadian should have to pay out-of-pocket or be billed for these services.
In addition, our Canadian tradition supports hospitals as non-profit public institutions, meaning that any surplus of revenue over expenditure must be plowed back into more health care.
Within the last several years, however, a threat to this altruistic societal agreement, has come onto the scene. It has been said that the greatest malady of the 20th century is "loss of soul" and it should surprise none of us to see this malady reflected in the major institutions and structures of society, including the health care system. Health care has grown increasingly mechanistic, commercial and soulless.
Under the rubric of a need for economy, we have downsized, rationalized, re-engineered, and reorganized but all too frequently our efforts have simply created anorexic organizations, reciting a "lean and mean" mantra, and threatening to fundamentally alter the trust and loyalty that grounds the physician-patient relationship.
The permanent removal of three hospitals from the public system in Calgary, despite soaring population increases, has also created strong community concerns about the unavailability of hospital beds and unacceptable lengthy waiting lists for services.
Legislation is now being proposed that will allow regional health authorities to contract with private for-profit providers for surgical services requiring overnight stays, effectively creating for-profit private hospitals within the public health system.
This push to for-profit care implicitly assumes that for-profit care is more efficient and that more operations can be performed contracting with private facilities than by increasing funding for public hospitals.
Are these assumptions supported by any hard factual data? The literature would suggest the contrary.
In Canada there are very few for-profit hospitals. However, the U.S. has a long experience with for-profit hospitals and they cost more, not less, than non-profit facilities.
Harvard medical school professors Drs. Woolhandler and Himmelstein published a paper in 1997 in the New England Journal of Medicine which analyzed 1994 data from all 5,201 U.S. acute care hospitals. They found that for-profit hospitals were 25 per cent per case more expensive than public facilities.
The single most compelling finding of the recent report, Private Profit or Public Good: The Economic and Politics of the Privatization of Health Care (Parkland Institute at the University of Alberta), is that for several decades and in various countries, private for-profit health care has been shown to consistently fall short of non-profit and publicly provided health care.
When compared to publicly-provided health care, private for-profit health care typically costs more; provides lower quality or fewer services; reduces equitability, accessibility, and fairness; drives up costs in adjacent public health services; and/or creates a range of other problems.
Under the banner of "efficiency," the private for-profits have as their ultimate goal - creating shareholder wealth. Investors typically expect returns and growth of 15 per cent annually.
In the for-profit model, any surplus of revenue over expenditure is not plowed back into more health care. Instead, the excess profit is paid out to the corporate executives who run these businesses and to the shareholders who support them. The money leaves the health care system.
Rather than continuing the shift of health care towards a bottom-line, business-oriented and profit-driven investment opportunity for shareholders, a stronger case can be made that funding be given to regional health authorities to re-open beds and operating rooms in public hospitals. The solutions do not lay in further privatization but rather repair of the public system.
It is clear that our superb system of non-profit maintenance and delivery will not be safe until the public becomes aroused to the need to save it. The public is awakening to this complex issue but it is not yet fully awake. Hopefully we won't sleep through the alarm!
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