Unhealthy secrecy surrounds public health care

Due to conflict of interest, governments
avoid clear performance measures for Medicare

Greater competition, better regulation, among needed solutions
 HALIFAX — The Atlantic Institute for Market Studies (AIMS) today released its most recent report on the state of Canada’s health care system entitled, “Public Health, State Secret”. The study demonstrates that politicians and senior health officials simply don’t know where or why medicare is failing because they still lack the proper tools to evaluate the quality or timeliness of the care Canadians receive. More to the point, the authors demonstrate why, under the current system, it is not in the government’s interests to know what is really happening in health care.

“Governments that simultaneously act as the insurer, service provider, and evaluator of health care quality, are in a conflict of interest,” says report co-author Dr. David Zitner, Director of Medical Informatics at Dalhousie University . “If they collect and provide clear and easily understandable information about the system’s performance, the public and health care professionals will use that information to criticize them and hold them accountable for poor performance.”

This conflict of interest serves to perpetuate a system that functions as an unregulated monopoly, with no defined performance standards for the quality and timeliness of the services it provides. The result is declining standards of care, closures of hospital beds, lengthening waiting times, labour disputes, and shortages of skilled labour.

“The current health care system is missing the basic information essential to its proper management and improvement,” says Zitner. “Basically, reform proposals are whistling in the dark with no clear evidence to indicate what is wrong or what can be done to fix it.” {clipped} 1/20/02

The report authors, Dr. David Zitner, AIMS Fellow in Health Care Policy, and Brian Lee Crowley, AIMS President, have done several previous works in healthcare and are actively involved in its reform. Crowley is a member of the Alberta Premier's Advisory Council on Health chaired by former Deputy Prime Minister Don Mazankowski. Public Health, State Secret more fully explores some of the themes and arguments that are presented in the recently released report of the Advisory Council, A Framework for Reform.

See also: Operating in the Dark: The Gathering Crisis in Canada’s Public Health Care System (requires Adobe Acrobat Reader) This study garnered considerable attention when it was published in November 1999 for its argument that the health care system could not be properly managed because managers and policymakers did not have access to vital information about the system’s performance. The paper also argued that if Canadians wanted to preserve the key elements of the system, and particularly a tax-financed approach that did not distribute medical care on the ability to pay, then greater private sector participation in health care provision was virtually unavoidable.