.. 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 Canadian Health Care 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 Canadian Health Act that explicitly state that ‘the provision of medically necessary services shall not be for profit and shall be publicly funded,” according to 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 increase of 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 Canada’s 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 individual’s 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, and 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 and government, 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 and 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, as stated previously. 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, (waiting in line), to decreasing accessibility and to diminishing quality”, (Dirnfeld, 1996, p.409). Supporters of private health care 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. According to Gordon, Mintz, and Chen (1998), 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 Canadian 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 as stated in the Canada Health Act (AARN,1995). Nursing also prides its self 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. The Future of Canadian Health Care The British Columbia Office of Heath Technology Assessment or (BCOHTA) as it is commonly called is based at the University of British Columbia in Canada. The purpose of the (BCOHTA) is to develop collaborative partnerships with evidence based Health Care programs that include the: ? British Columbia Cancer Agency ? British Columbia Center for Disease Control ? Center for Applied Ethics, USB (University of British Columbia) There are more than 25 programs that the BCOHTA has a partnership with. What does this mean? It means that with theses partnerships can analyze problems that Canada is having with the current health care system.
They do it in the following ways: First they provide a replicable, defensible method to determine the state of scientific knowledge in any given clinical discipline or health program. Second they can direct researchers within an institution towards significant knowledge gaps. Finally, this approach will help institutions give priority to topics with impact on patient health and health care costs, and thus serve a substantive public interest. 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 Canada’s 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 Canadian 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. Social Issues.