Canada uses a mix of public and private organizations to deliver health care but is financed with public tax dollars.

Historically, doctors have billed the provinces on a fee for service basis. This differs from the United Kingdom where most medical services are provided privately but paid for by government.

In Canada, health care is a provincial responsibility so the provision and standards of healthcare are not pan-Canadian although the Government of Canada sets the rules of delivery via various funding formulas.

Publicly-funded insurance is organized at the level of province/territory; each manages its own insurance system and issues its own healthcare identification cards. Once care moves beyond the services required by the Canada Health Act, for which universal comprehensive coverage applies, there is some inconsistency in the service delivery for such items as outpatient drug coverage and rehabilitation, vision care, mental health, and long-term care.

The Canada Health Act requires coverage for all medically necessary care provided in hospitals and/or by physicians including: diagnostic, treatment and preventive services. Coverage is universal for Canadian residents, regardless of income level.

Election of the new president of the Canadian Medical Association (CMA), Dr. Robert Oulette has sparked concern among some groups of Canadians because the doctor advocates more private delivery of healthcare services. Canadians have long clung to the notion that health service delivery is and should remain “universal”.

Universality implies that healthcare is provided without limit or exception and is available equitably to all members of society. Oulette claims that Canada’s healthcare system is not universal, that it is only half universal because it does not include prescription drugs.

At least 600,000 Canadians, a majority of them live in Atlantic Canada, have no drug coverage. Another six million people have inadequate coverage. According to the Canadian Institute for Health Information, Canadians spent $20.6 billion on prescription drugs in 2007 – it’s big business.

Prescription drug plans differ across the country. Some provinces cover prescribed drugs for specific age groups (usually, seniors) and/or those on social assistance. Quebec is the only province with a universal prescription drug plan. Dental care is not covered by government insurance plans so Canadians have to rely on their employers, private insurers or personal cash payments to fund their dental care.

The non-debate in Canada confuses universality and the delivery of government-funded services by private sector providers. Dr. Oulette defends universality but would expand private delivery of medical care. The Canadian Nurses Association advocates a not-for-profit health-care system and rejects Oulette’s notion that some form of privatization would improve efficiency, effectiveness of service or access to the system.

Dr. Oulette suggests that surgeons should be able to work in private, for-profit clinics while at the same time working in publicly funded hospitals. In the current day, surgeons who want to set up private practices (funded by patients as distinct from government funded health insurance) must opt out of Medicare.

I have argued before that doctors would be compromised by a two track delivery system. On the one hand, they would have access to fixed rate, volume funding from government and on the other hand they would be offering services on a “what the market would bare” basis. These raise two issues: (i) if the private service proved to be more lucrative, services to the public would/could be reduced and (ii) people of means would have greater access to medical services because they could afford to pay the premiums demanded by private sector practitioners.

I have no issue with healthcare services being provided privately so long as they are funded by the public sector and so long as they are available to everybody on an equitable basis and without prejudice of income. Increased delivery of healthcare services by the private sector could bring new efficiencies to the system, maybe even reduce wait-times

To provide context, it’s useful to know that Canada has more than a million patients waiting for care and five million people without a family doctor. The United States has 46 million people with no healthcare insurance and little access to the healthcare system.

Dr. Oulette suggests that competition; consumer choice and market principles should rule the delivery of healthcare services in Canada.

In my opinion, that is code for two-tiered service delivery – those who can afford to pay have a choice of services and service-providers, those who cannot afford to pay only have access to a queue of publicly funded healthcare services and publicly funded healthcare providers.

There is a role for competition, user choice and market principles in the delivery of healthcare services but somehow they have to combine under the principle of universality. The person who finds the formula could become a wealthy human being.

W.E. (Bill) Belliveau is a Shediac resident and Moncton business consultant. He can be contacted at bill.bellstrategic@nb.aibn.com Atlantic Insight is a published Blog inventory of opinion articles published weekly in New Brunswick's print media as written by W.E. (Bill) Belliveau, who is a resident of Shediac, New Brunswick, and small business owner, operating his Moncton-based marketing consultancy, Bell Strategic. He can be reached by e-mail at mailto:bill.bellstrategic@nb.aibn.com