Monthly Archives: April 2006

The Third Way

The public has had plenty of time to weigh the pros and cons of Premier Ralph Klein's proposal to introduce a two-tier health care system. In the Calgary Sun, the, and, it is argued that a two-tier health care system will have detrimental effects, such as queue jumping, conflicts of interest, attracting rural health care workers to urban locations, and penalties under the Canada Health Act [CHA]. However, the act of listing out cons tends to ignore the assumptions that they are based upon.

First of all, it appears to be unfair to allow people to queue jump for treatment because they possess a greater amount of wealth and are willing to pay the costs of private health care. However, there is a difference between those who are 'willing to pay' and those who are 'rich'. To suggest that queue jumping is something to be frowned upon and only available to the wealthy ignores the possibilities queue jumping offers. One of the main objectives for the Canadian government is to reduce wait times. Queue jumping may contribute to that objective by shunting people who are waiting for a particular treatment to a private alternative, freeing up the public system queue. Although those who receive treatment earlier through the private tier must be willing to pay for it, the strains on the public system are nevertheless alleviated. Ideally the public sector will provide timely service for all types of treatments to all who require it, but there will be situations where even the best standardised wait times deemed appropriate by the government do not suit the needs of the public.

Secondly, the argument that a two-tier system will create a conflict of interest for doctors assumes that patients cannot weigh the advantages and disadvantages between the public and private sector for themselves. Patients can judge the character of the doctor they are seeing and evaluate how their needs can be met by either tier. One possible solution would be to encourage more dialogue between the patient and other health care workers in order to promote accurate information to prevent or minimise abuses. On the other hand, doctors might avoid discussing private alternatives entirely due to the fear of disgruntled patients raising accusations of unethical conduct against them.

Though conflicts of interest are a serious problem with a two-tier system it can possibly provide benefits to health care workers by providing a private alternative for skilled, educated people who are considering a career in the United States for the promise of improved incomes. Young health care workers and doctors can take advantage of the experiences the public sector offers and provide their skills to the private sector while remaining within the country, countering the age-old matter of Canada's 'brain drain'.

As for the penalties that may be incurred under the Canada Health Act 1985 [CHA], it can be seen from the position of Premier Klein that they are clearly not enough to deter a province from pursuing private health care. Moreover, while the Klein government has been criticised for providing vague details of the 'Third Way', the CHA is not without flaws.

Fourthly, the argument that a private health care system will act as a magnet for rural health care workers is doubtful because conflicts always exist between the demands of rural and urban populations. The effects of a two-tier system will certainly contribute to this conflict, but it is premature to argue that the rural health care system will suffer detrimentally due to an increased prevalence of private health care. A two-tier system may create private alternatives that are closer to rural populations rather than force patients to resort to treatments administered in other provinces or states.

One final assumption that seemingly underlies these four disadvantages is that a two-tier approach to health care will essentially create a mirror image where a complete, private system will compete with the public sector. However, it is unlikely and somewhat difficult to imagine this situation due to the competitive advantage of public health care. From the Information Technology for Management Glossary the definition of competitive advantage "is an advantage over a competitor such as lower cost or quicker deliveries." Many public health services are well entrenched, making it difficult for private firms to establish themselves unless they offered something unique. In addition, there will be areas of health care where the skills of the public sector are absolute and will generally be avoided by the private tier. Private tier health care delivery is further restricted due to the fact, "…[i]n practice, few physicians leave the public system because it is hard to attract a sufficient number of patients who want to pay full health-care costs when they also have access to the public system" [The Canada Health Act: Overview and Options (94-4E)]. Essentially the private sector will find opportunities in areas where the public system is relatively slow and bogged down.

It can be seen that privately funded and delivered health care can have positive (heh) effects, but the fact is there will be problems for both single and two-tier systems due to the complexity of delivering health care to an entire country. The very purpose of discussing the 'Third Way' is to explore alternatives to providing timely, quality care to as many people as possible and this requires contemplation upon the possible advantages a private sector approach has to offer.