Experiments in private healthcare

Stephen Harper supports private sector delivery of some health services. Pierre Pettigrew did too, ever so briefly, but has since corrected himself. On the frontlines, private diagnostic imaging centres are opening in parts of the country while the feds warn that using them could jeopardize transfer payments. But don't call us wishy-washy. We're just new at this.

There may well be areas of healthcare that can be carved out of the public administration and transferred to private sector providers. We may even be able to do this and preserve the valued right of all Canadians to have universal access to healthcare on the basis of need not money. Believers point to European countries, many of which have gone that route to varying degrees. But before we take off after them, why not look at our own 30-year experiment with private participation in laboratory services? Results there have been short of satisfactory for any of the partners involved, be it government, companies or patients.

Governments were initially pleased to save on some of the capital expenditures needed to update lab technology in public facilities. They signed contracts for outpatient testing with companies like MDS and Dynacare, who soon found they'd underbid for the amount of testing actually expected from them. Despite this, these companies went on to secure lucrative American contracts. Michael Decter, chairman of the National Health Council, attributed their US success in part to their experience in trying to please the most miserable of all customers, the Ontario government, which continually demanded more service for lower prices.

As these companies began to consolidate to remain profitable, patients were left with fewer and fewer service options. To make matters worse, government efforts to control the coverage list of privately provided lab services made it nearly impossible for new tests to make their way in.

The result? Patients are going back to hospitals to get the tests they need because they aren't covered when done by a private lab. Hospital labs are growing and undergoing their own form of consolidation to improve efficiency. Some provinces have even stopped funding private lab tests altogether.

As with any other intractable health problem, the diagnosis and prescription for private sector involvement should be based on sound laboratory analysis.

� Susan Usher, Health Policy Editor