Professor Golden: What is your view on the advent of private healthcare?

As long as there is proper oversight and governance, I am not concerned. There are private alternatives in virtually every other country. I think many people confuse or conflate private delivery with private payment. We are not talking about preferred access to care as a result of having more money in one’s pocket. We have a considerable amount of private delivery already in this country, and this isn’t the first time we’ve seen the need for other options. Approximately 20 years ago in Ontario, we had an incredibly long waitlist for radiation oncology services. Patients in the GTA were forced to go to Thunder Bay or to Buffalo, where it was considerably more expensive. What the Government at the time did was create a contract for private clinics to offer these services. It was paid for by OHIP at the prevailing rate, and in a year and a half, the waitlist was fully eliminated with no extra expense to the province.

We don’t have to use the U.S. as a comparator. We can look to the UK’S National Health Service (NHS); we can look to Australia, Switzerland, Singapore and Israel. There are many other systems with a mix of public and private care. We just need to carefully monitor quality and access. We actually need oversight around these things in both the public and private systems.

Another question is whether this will increase capacity in the system or if we’re just shifting capacity. Are we going to lose health human resources from the public system to the private system? There is good reason to believe that we can increase capacity; people may choose to work more hours if they work in a private environment. Most physicians in the private system in the UK’S NHS spend about 80 per cent of their time in the public system. Importantly the system does provide preferred access to those who can pay privately. That’s not what we’re talking about in Ontario. OHIP will continue to pay, not patients, whether with publicly owned or privately owned providers.

Ideologically, many people are concerned about a capitalist system emerging. But if we do see a shift — let’s say nurses moving from the public system to the private system — that just tells us they’re not happy in the public system. Why in the world would we feel comfortable restricting the job mobility of nurses? If done right, the changes we are talking about provide the opportunity for better access to care, better working conditions and high quality care.

–From The Healthy Debate: www.healthydebate.ca