In the past, Canadas government-funded, universally accessible, health care system has been praised and admired both at home and abroad as one of the finest in the world. A great source of pride and comfort for many Canadians is that it is based on five fundamental principles. Principles that are a reflection of the values held by Canadian citizens since the formation of Medicare in 1966. These principles were reinforced in the Canada Health Act, (CHA), of 1984 and state that the Canadian system is universal, accessible, portable, comprehensive and non-profit.
With increasing concerns of debts and deficits, Canadas publicly funded health care system has recently become the target of fiscal attack. Efforts to reform and restructure the system have produced few results. Currently, some governments throughout the country are looking towards a more radical approach. An approach that would see not only the reform and restructuring of the method of operation of the current system, but that would change the system entirely. The proposed idea? In Alberta, it is to increase the role of the private sector in the current system.
On December 29th, 1999, Nancy MacBeth leader of the Alberta liberal party was cited in the Edmonton Journal as saying: Theres ample evidence that the Alberta governments plan to expand the role of private health-care will contravene the Canada Health Act. This is the strongest argument against privatization. It reflects the fears of many Albertans and Canadians; the fear that a two-tier system similar to that of the United States will develop. The fear that the system which was built upon values reflected in five principles will be eroded and replaced and that they will be the ones left to suffer the consequences.
Privatization of health care would undermine the principles of the Canada Health Act and as such would undermine the integrity of the health care system. The evolution of Health Care In 1966 one of Canadas most prided achievements to date was introduced to the Canadian Health Care system. Medicare was a daring and innovative concept pioneered by Canadians for Canadians. It revolutionized health care. Canadians overwhelmingly supported the new system as it reflected their values and the import they placed on universality and equal access to health.
Now, in the dawn of the millennium, the ideals of the same system are in jeopardy. Albertans are at present feeling the effects of restructuring. Accessibility and quality are being threatened due to cutbacks coupled with a lack of funding. There is a consensus now between medical professionals, the public, and the government that the health care system is deteriorating. It is failing to provide the quality of care promised in the CHA and prided by so many Canadians. Yet the strings on the public purse continue to tighten.
Transfer payments from the federal government continue to decrease as provincial debt loads increase. And, although the minister of health and the premier assured them that the costs of health care were doubling or even tripling, Albertans have witnessed a steady decline in government spending on health care. The proportion of gross domestic product, (GDP), which Alberta allocates to health care is ranked last among the ten provinces, (Taft, 1997). Albertans now find themselves with a struggling health care system and a waiting list.
The proposed solution from current Alberta government would see the health care system incorporate the private sector. The government Most of all the government is looking to decrease cost, increase accessibility and efficiency. * . Universality and Accessibility vs. Choice Universality and accessibility go hand in hand. They are the principles that assure that each Canadian regardless of financial situation, will have equal opportunity to access the same level of care. The lack of a private market in the current system, some will argue, limits the individuals freedom of choice.
Supporters of privatization maintain that these principles conflict with Canadians right to choose; the patients autonomy to choose to pay privately, and the physicians choice to provide preferential treatments to those payers ( Dirnfeld, 1996; Gordon, Mintz & Chen, 1998). Increasing choice in this manner would lead only to such detrimental practices as cream skimming, (Dirnfeld, 1996). Insurance companies would want only to provide coverage for those who meet certain low-risk physical criteria; physicians could care for those who could pay or for those who diagnosis proved to be the most profitable.
This would be leading Canadians to take giant leaps backward in health care; moving towards the medical model of old that focused on disease and cure rather than health promotion and disease prevention. With privatization comes private insurance, which can then delegate the what, whom, where and when health care services are accessed, in turn greatly limiting the individuals choice (Armstrong & Fegan, 1998). Utilization of a private for-profit system will be restricted to those who have adequate insurance coverage or the ability to pay out of pocket.
Accessing services could also become dependent on hours of operation and rights to different facilities as dictated by private business owners and restrictions imposed by insurance plans. Accessibility will also be affected when for-profit hospitals determine where to be established. Many Albertans live in rural areas too sparsely populated to encourage free-market competition. As more populated areas are bombarded with a barrage of health care competitors vying for their money, rural communities will be abandoned. Businesses and employees will be lured away by the prospect of fatter pocket books as profit is exchanged for people.
Decreasing Cost vs. Non-profit One of the driving forces behind privatization is that it will cut and control increasing health care costs. There is a belief that a private for-profit market will create competition between health care providers. This would then reduce cost to the consumer as the different companies compete to obtain business. There have been however, many instances that have shown the effects of privatization to be just the opposite. For example, in order to remain competitive, money will have to be invested in advertising and marketing, a cost that is not present in the system as it stands, (Wilson, 1995).
Health care is not a place for the free-market competition. As a consumer one is driven to shop around for the best product for the best price. It is simply not feasible for an individual to wait for a medical service to go on sale or to exchange the same if not 100% satisfied. Nor is it consistent with the principles of the CHA that explicitly state that the provision of medically necessary services shall not be for profit and shall be publicly funded, (Armstrong & Armstrong, 1996). It explicitly contradicts a value on which Canadians founded their beliefs of what constitutes Health Care in Canada.
Simply the operation of a private system will likely lead to increased costs. Less bureaucracy in a public system eliminates the extra expenses often attributed to the higher overhead and increased operating rates, (Armstrong & Fegan, 1998). These costs are incurred from the paperwork and administration necessary to regulate a private system. In Canadas single-payer system it is not necessary to make an itemized list of the equipment used per individual patient in order to draw up a bill for services. In a single-payer system it is also not necessary to keep records of each individuals insurance plan and their payment and treatment options.
In fact, in the past, when Canada has moved to de-insure medical services, (i. e. : eye exams, prescriptions), it has actually indicated increased cost for the consumer, (Armstrong & Armstrong, 1996). In all, increasing privatization will likely do little to reduce operating costs of the health care system; rather it will simply shift the burden of cost. With increasing privatization, the responsibility for payment will no longer fall on the public purse but will instead become the responsibility of the individual, (Armstrong & Armstrong, 1996).
Efficiency and Quality The increasing competitiveness that comes along with for-profit markets, many believe, will reduce waste and increase efficiency. Because the private market is more concerned with controlling costs in order to increase profit many believe that there would be more efficient waste management and less abuse or misuse of health care resources. However, there is little solid evidence that the current system is abused or subject to overuse, (Armstrong & Fegan, 1998; Wilson, 1995).
In fact, if the private sector allows money to govern health care administration the possibility exists that business will diagnose and treat simply for the sake of profit. Both those who support and those who oppose private health care recognize that the quality of care is suffering. Supporters of privatization believe that it is the tyranny of a single-payer, which has led to rationing through the use of queues, to decreasing accessibility and to diminishing quality, (Dirnfeld, 1996, p. 409). They believe that a private option in health care would decrease waiting lists for public facilities.
This, in turn, would improve access for those using the public system. Evidence shows that an introduction of the private sector would not reduce waiting lists, rather it would alter the way waiting list are structured and prioritized. Instead of greatest necessity being moved to the top of the list, those who could pay would jump the list and receive the care they required. Implications for nursing practice Nursing is a profession based on ethical principles. One of these principles states that nurses must be accountable for their actions and the care they provide.
If there is an influx of the private for- profit sector into the health care system accountability is threatened as hospitals decrease standards in order to increase profit. Nurses are also ethically responsible for assuring that clients are provided with safe, competent, quality care (CAN, 1997). As previously stated, a decrease in quality is inevitable as money becomes the driving force behind health care provision. The ethics of fairness and equitable distribution dictate that health care should be based on need rather than ability to pay.
This belief is reinforced by the AARN who, in their position statement on privatization, affirms its loyalty to the maintenance of the principles of the CHA (AARN,1995). Nursing also prides itself as a profession that takes a holistic approach to providing care for the individual. As the medical model and profit align to affirm their position of authority in health care it is the client who would suffer. There would be an urge to focus on a quota of parts to be fixed in a specified time frame rather than to focus on the individual and their specific needs.
Armstrong & Armstrong, 1996). Neglecting the principles of the CHA in order to incorporate privatization will have detrimental effects on the integrity of nursing practice. Conclusion All of this is by no means meant to indicate that the current Canadian Health Care system is ideal. Nor does it stand to say that radical restructuring is not necessary in the evolution of Canadas Health Care system. Rather that the restructuring necessary for the system to thrive needs to be undertaken as a holistic approach, not simply focused on cutting costs for the public sector.
Cutbacks and downsizing are not the means by which to rejuvenate an ailing health care system. Nor is the introduction of investor-owned hospitals that strive to maximize profits, not to decrease costs. Reform and restructuring need to start at the bottom; fundamental changes need to be made in the way we view health and health care. The focus needs to continue to move away from the medical model of the past to one that promotes health and prevents illness, accommodating the needs of a changing population, while maintaining the fundamental principles of the Canada Health Act.