Will the new health accord include a privatization clause?

Will the federal government insist the provinces “experiment” with for-profit delivery of health care as part of the next Canada Health Accord?

Colleen Flood says there is “some talk” that this may be a new condition. Flood, Canada Research Chair in Health and Law Policy at the University of Toronto, told Canadian Business magazine that it “may be a condition that the feds actually put on the transfer, the condition of experimenting with private for-profit delivery within the context of a public system.”

The idea wouldn’t be entirely new – the Harper government set a similar proviso to new infrastructure projects requiring federal funding. The Conservatives set a condition requiring the provinces to examine the “viability” of public-private partnerships on any infrastructure projects seeking at least $50 million in federal funding.

The idea of embedding the new health accord with a privatization clause may be disturbing to Canadians. Canadian values have long rejected the idea that health care is a business venture rather than a “moral enterprise.” Will that belief apply to private for-profit delivery of publicly funded health services?

The problem is the feds appear ready to dash into this without any evidence to support it.

The Romanow Commission found no advantage to the delivery of public health care services by private for-profit entities. In the US, an influential 2002 meta-analysis by P.J. Devereaux concluded that for-profit ownership of hospitals and kidney dialysis clinics led to poorer outcomes and higher mortality rates. A BC study of for-profit versus not-for-profit long term care homes came to similar conclusions.

At a recent conference held by Students for Medicare, Dr. Michael Rachlis said Canada’s health care costs rose faster in the private sector. Governments were far more successful in restraining rising health costs in the public sector. Hospital and physician costs have been amongst the slowest to rise.

Once that pandora’s box is opened, can it be closed again?

Critics suggest that private delivery is not the edge of the wedge towards full privatization. They suggest that Canadians would never accept an Americanized system. However, we have already seen delisting of services, something anticipated to increase. Delisting is the ultimate privatization. When the McGuinty government first came to power in 2004, physiotherapy and eye examinations were among health services to be delisted.

Following public uproar a compromise was reached where hospitals were left performing publicly-funded outpatient physio. That didn’t last long — over the last eight years these services have slowly dried up as individual hospitals have stopped offering outpatient rehab services.

Now we are seeing less subtle forms of privatization, such as the recent news that the Scarborough Centenary Hospital – part of Rouge Valley Health System – is charging “alumni” in its cardiac rehab program $500 a year to continue on with the program.

The attack on our public Medicare system will likely not be a full frontal approach. That would be too toxic for any politician. It is more likely we will see the system eroded by increments, making way for greater opportunities by the private sector.

How the federal government proceeds will be watched closely by all who value our Medicare system.

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