Ottawa, Ontario, August 16, 2007 – Canadian doctors, members of the Canadian Medical Association, will be meeting in Vancouver next week from August 19 to 22. On the agenda for resolutions and discussion will be activity-based funding, a system that proposes to finance health care according to volume and type of service instead of via global funding, as is the current situation.
A letter from British doctors to the Canadian Medical Association (CMA), the second of its kind, raises serious questions and advises Canadian counterparts of the pitfalls inherent in a number of proposals for privatization. In the letter, Dr. Jacky Davis and Dr. Peter Fisher, executive officers with Britain’s National Health Service Consultants Association (NHSCA), advise members of the CMA to beware of the fantasy fixes suggested by privatization. Dr. Davis’ letter makes it clear that the romance with privatization in Great Britain’s health care system is over. Both the newly appointed Minister of Health and the governments of Scotland and Wales have called for a serious reduction and even an end to the privatization of services. The British Medical Association also opposes the competition model.
Dr. Davis and Dr. Fisher write, “Those in support of privatization often cite the ‘English Experiment’ as proof that the private sector can “save” public health care. They point to significant reductions in waitlists since the reforms were established. However, that is hardly surprising given that health spending has more that doubled since 1997. The reality is that money has been lavished on politically sensitive wait lists for elective surgery through expensive and unsustainable deals with the private sector. This has been to the detriment of many patients with more long term needs.”
Dr. Davis and Dr. Fisher indicate that doctors, including members of the British Medical Association, and politicians throughout Great Britain, are becoming weary of solutions that result in higher costs and increasingly limited access to services.
When it comes to “performance-based funding, known in Britain as performance-by-results (PbR), Dr. Davis and Dr. Fisher are unequivocal: “This shift [to payment by results] – begun three years ago - has resulted in so many perverse incentives and unintended consequences that its future is now in doubt. One downside particularly relevant to you [Canadian doctors] is the fact that PbR may lead to unnecessary admissions.”
Examples of activity-based funding initiatives already exist in B.C. and Ontario. The B.C. government’s new $16.4 million performance-based hospital funding pilot project uses a commercially-inspired incentive system to achieve outcomes that could be achieved with a global budget and a democratic, evidence-based decision making process – one that uses less overhead. The $1 billion Ontario Wait Times Strategy is also a concern because it prices procedures, rewards competition between facilities, and favours specialized hospitals.
The current leadership of the CMA is advocating more, not less, private sector involvement in Canada’s health care system. Specifically, the recent CMA policy paper titled Medicare Plus recommends that government allow Canadians to purchase private health insurance and allow doctors to practice in both the public and private system. It also urges governments to consider funding private sector health services.
The British experience should tell Canadian doctors and Canadians that strong public policy providing for stable funding and collaboration, not marketing miracles and private investment, are needed to move Canada’s health care system forward.
“We must conclude,” says the British doctors’ letter, “that neither payment by results, the increased use of the private sector or the ‘patient choice’ agenda have proved their worth. On the contrary, they have resulted in a destabilized and damaged public service. The government has sought to introduce a set of policies for which there is no evidence, policies which are incoherent and contradictory. These policies have fragmented health care, discouraged collaboration between healthcare professionals, and wasted money. This is why patients, the public and healthcare workers are seriously worried.”
The full letter can be read or downloaded at http://cupe.ca/healthcare/NHSCAletter. The National Health Service Consultants’ Association represents 650 British specialists in a broad range of practices. Visit http://www.nhsca.org.uk/ for more on the NHSCA.
CUPE is Canada’s largest union. There are over 170,000 CUPE members working in hospitals, long-term care facilities, continuing care, home care, community clinics, public health units, emergency medical services, and diagnostic services across the country. They work as cleaners, care aides, licensed practical nurses, technicians and in many other jobs throughout the health care system.