| Who’s afraid of public health care?

With a debate raging down south over the possibility of a public option in Obama’s health care plan, Canada’s public system has gotten some flak. In conversation with The Daily this week, three McGill experts commented on the fine points of creating a more efficient and accessible health care system.

It’s not the public system that keeps you waiting
Despite horror stories of Canadian patients who would’ve died waiting for surgery if they hadn’t gone to the U.S., Vedat Verter, professor of Operations Management at McGill, refutes the claim that long wait times are a problem inherent to public health care systems like Canada’s. “In the U.S. you may be waiting for them to see if you can pay or not,” he said.

External factors such as the closing of other health care facilities in the surrounding area clearly have an impact on crowding in hospitals. But allocation of resources within each medical facility, and within the country’s health care system at large, also plays a deciding role in how long patients have to wait to get treated. At McGill, Verter works on creating simulation models of emergency room situations, based on “tens of thousands of replications in which patients flow through the system similarly to how they would in real life.” The simulations indicate areas where more doctors or nurses are in especially high demand. Other simulations compile past data in order to provide more accurate dosages of medicine to patients with chronic conditions, preventing the “revolving door” effect, in which patients worsen and go to the emergency room, are treated and discharged, only to worsen again and repeat the cycle.

A prime strategy to reduce waiting times, Verter emphasized, is to invest in preventative care. “The World Health Organization estimates that North American governments spend less than five per cent of their health budget on prevention,” he explained. But in order to be effective, investment in preventative care must be well-managed, balancing the creation of new facilities with health promotion campaigns that get people to use them. “Preventative care requires participation,” he explained. “And an alternate way to increase participation is to educate people.”

Putting a price tag on health
Amélie Quesnel-Vallée, a medical sociologist, conducts research on the effects of social policies on health inequalities. She focuses in particular on private health care as part of a research lab that studies and compares the health policies of 21 countries. The group is currently into their first six months of a five-year project.

She explained that, though the hypothesis that use of private insurance and treatment facilities takes pressure off the public system is a fairly intuitive one, empirical studies show this isn’t the case. Privately insured patients can jump the queue by getting diagnosed in private facilities, but then choose to be treated in the public system. Moreover, the private sector is set up to handle simple cases with quick recovery times, leaving complex cases to the public system.

Quesnel-Vallée also noted that the increasing prevalence of private health care can weaken the integrity of the public system. “The theory behind public health insurance is that it should reduce the effects of socioeconomic status on health,” Quesnel-Vallée explained. “If you take off a portion of the population [which is privately insured], they come to be disengaged from the public system, and ask for lower taxes. You have to have a very strong sense of solidarity to keep considering this a public good.”

No magic bullet
As a specialist in medicine, ethics, and law, Margaret Somerville hears a lot about bad experiences with the public system, and welcomes experiments with privatization. “Canada’s had this identity crisis that if we let any private thing into our healthcare system, we can no longer say we’re Canadians.” This, she explained, is slowly changing — in part out of necessity, and in part because of a recent Supreme Court of Canada case that ruled it infringment on the security of the person to prohibit anyone from using private insurance.

From an ethical standpoint, Somerville takes issue with leaving thousands of people uninsured, as they are in the U.S. “In a caring society, everyone should have access to a reasonably adequate level of health care.”


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