Should governments look to public-private partnerships
(P3s) to cure all that ails healthcare? Manitoba says
"no" and Nova Scotia says "maybe" but then along came
the Supreme Court, throwing a wrench in the works with
a decision that's widely seen as a threat to the public
healthcare status quo. Whatever the provinces decide to
do, it looks certain that these businesses will be playing
an ever-bigger role in treating Canadians in the days
to come.
Would you look askance if a businessman
said he wanted to sell you something at cost? Well the
Manitoba government did just that when they decided
that the private Maple Surgical Centre's offer to perform
not-for-profit surgeries for the province sounded a
little too good to be true. "We're trying to help,"
says Don Copeman, the CEO of Surgical Spaces Inc, Maple
Surgical's parent company. This February, when the firm
offered to reduce Manitoba's waiting-list for day surgeries
by supplying operating rooms, nursing care & surgical
supplies to the government at cost, their offer was
greeted first with silence and then it was unceremoniously
rejected.
"Maple Surgical has made various
proposals to us on a number of occasions," says Joel
Hildebrand, communications officer for Manitoba Health.
"None of them have made financial sense." Mr Hildebrand
believes that Manitoba has no lack of surgical space,
but a lack of doctors to use the existing space. Manitoba
Health hasn't completely refused to contract insured
health services to private companies — it continues
to contract out cataract surgeries to Western Surgery
Centre, another private facility in Winnipeg —
but doesn't believe that more P3s would save money in
the long run.
"We believe that through the public
system we can provide better care — and better
care sooner — to Manitobans," says Mr Hildebrand.
So what of that doggedly controversial
question — should the provinces move from a purely
public system to one that relies more on private firms
for delivery of essential health services? Well, Alberta
unsurprisingly embraced healthcare P3s with their acceptance
of the Premier's Advisory Council's Framework for
Reform in 2002, and BC and Ontario have moved into
significant use of private facilities in recent years,
however many governments still regard private overtures
with great caution.
NOVA
SCOTIA'S P3 OFFER
In Halifax, Nova Scotia, Dr Dan Belliveau, an ophthalmologist
and assistant professor at Dalhousie University who
runs his own private surgery clinic, recently made a
proposal to the Nova Scotia government to have cataract
surgeries done at his clinic. He believes he can deliver
this service at approximately 70% of the cost of the
same procedure when done in a hospital.
"Premier Hamm, who's a doctor himself
here in Nova Scotia, said about three weeks ago that
if the current rate stays the same... in twenty years,
100 percent of the budget would be going toward delivering
healthcare," says Dr Belliveau. "I'm a taxpayer too,"
Dr Belliveau continues, "and I don't like it when I
go into a hospital and see that it could be done more
effectively." Dr Belliveau believes that the provinces
that have embraced P3s are on the right track, and hopes
that his own home province will take a look at moving
in that direction.
Cheryl Doiron, the deputy minister
of Health for Nova Scotia, hasn't seen Dr Belliveau's
proposal yet, but is reluctant to take a firm stance
on P3s until her department's discussion paper on private
sector involvement in the public healthcare sector is
produced at the end of June. At that time, her department
will seek input from all appropriate stakeholders.
A
DOOR AJAR
"To say that we would be against any kind of public-private
relationship is probably too extreme," says Ms Doiron,
but she does express concerns about maintaining control
of quality of service and equitability of access if
insured services are delivered by private facilities.
"We do not believe that the way to improve our wait
times is to see the private sector go out there and
set up business on a for-profit basis, and it's not
our intention to improve our wait times by going down
that road," Ms Doiron says.
Dr Belliveau and Mr Copeman are
in complete agreement that private-sector involvement
in healthcare is here to stay. They believe that governments
should take a proactive approach to management of public-private
partnerships now, and that government fears of loss
of quality control and private sector involvement leading
to a two-tiered system are unfounded.
2-TIER
ALREADY HERE?
"We have a two-tiered system now," says Mr Copeman,
"with the US being the second tier." He's referring
to Canadians who can afford to pay for their own surgeries
across the border rather than wait their turn in Canada.
He also fears that the aforementioned decision just
reached by the Supreme Court may throw Canadian doors
wide open to private healthcare — American style.
The Court heard an appeal from Dr Jacques Chaoulli and
Mr George Zeliotis, insisting Quebec's laws prohibiting
private insurers from covering health services, currently
insured by government, violates a person's right to
life, liberty and security of the person guaranteed
by Section 7 of the Canadian Charter.
The court sided with the challengers,
so it appears that Canadians will have the right to
purchase health services on their own, which might open
a whole new can of worms.
"I don't support widespread privatization,"
Mr Copeman says, "but governments like the one in Manitoba
are turning away, when they should be planning on how
to integrate private enterprise into the system."
For now it looks like Manitoba
is closing the door on more P3s in healthcare delivery
and Nova Scotia's health ministry may be giving any
gift horses that come their way a good dental exam.
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