We need to keep talking about public and private healthcare

Over the past year, I’ve heard from countless patients about their struggle to access health care in Canada.

One takes his cholesterol medication every other day – instead of every day as prescribed – to save on the cost of prescription drugs. Another struggles to access reconstructive surgery after having a cancer removed from her face. Patients who suffer injuries often feel compelled to go back to work while waiting for rehabilitation services, risking chronic pain and slowing the return to full functionality.

Patient experiences like these have prompted some governments to look towards the private sector to help expand access to health care – shifting a long-held balance between public and private care in this country. Is this the right way forward?

To understand what an increased role for the private sector means for patients, physicians and the public, and to update our 2007 policy, the Canadian Medical Association (CMA) has led a year-long national dialogue on this issue.

At four public town halls, 17 patient- and physician-focused sessions and through surveys, we heard from more than 10,000 Canadians on the health-care system they desire, and what they believe is the best way to close the gap with the health system we have.

Given the current state of the health system, some participants felt strongly that paying for timely care out of pocket should be a legitimate option. Many physicians expressed moral distress watching patients languish on lengthy waitlists for care, driving burnout.

But while there was recognition that private health providers are helping to address gaps in care, equity in care, regardless of the ability to pay for services, remained a bedrock value. I heard an overwhelming level of support for – and pride in – Canada’s universal health-care system and a desire to see more investment in it.

Where timely access is not possible in the public system, participants were most comfortable with private delivery of health care paid for by the government – not patients.

“No one should be left behind,” said one event participant.

While there has been a clear erosion of the public health system, I also learned that there are pockets of excellence across the country. Team-based primary care in which teams leverage the skill set of every health professional for optimal results, is one positive trend. Patient Medical Homes in Prince Edward Island, for example, are reporting success.

While there has been a clear erosion of the public health system, I also learned that there are pockets of excellence across the country.

Many participants also noted the importance of collecting and sharing standardized, accurate and reliable health-care services data on the handling of individual information, and keeping this information in a centralized place, to enhance transparency and accountability in health care.

There has been encouraging progress on this front, with recent legislation to enable Canadians to access their own health data and require companies providing digital health services to adopt common standards and allow for secure information sharing

The CMA’s guiding principle is that every Canadian should have access to high-quality, timely health care, regardless of their ability to pay, and that health workers deserve safe workloads and work environments.

Informed by these values, our national consultations, as well an extensive evidence review of existing research, the CMA has drafted an updated policy on managing the balance of public and private care rooted in seven key principles:

• Quality

• Accountability and transparency

• Comprehensiveness

• Integration

• Clinical autonomy

• Sustainability and affordability

• Professional responsibility

Following further consultations with stakeholders, we will release our final policy in the fall. We also heard a lack of understanding about how health care works right now, how it is delivered and how it is funded. To help Canadians make sense of a complex system, and make informed decisions on the future, we have launched an education campaign on our social channels and online.

As I prepare to end my term as president at the CMA, I am hopeful for the future of Canada’s health-care system. I’m grateful to the thousands of Canadians who participated in our national consultations, sharing their experiences and perspectives. These are and will continue to be uncomfortable conversations that we should be able to comfortably have together.

We are in a watershed moment for our health-care system — this is just the beginning, let’s continue talking about the health care we all want.

This article was originally published in Healthy Debate.