The role of the private sector in health care: CMQ sets out guiding principles
The situation is worrisome with regard to the growing difficulties of access to health care, the exodus of resources to the private sector, lengthening waiting lists for surgeries, and the need to regulate the terms and conditions of care offered in the private sector. The Board of Directors of the Collège des médecins has just set out guiding principles on the role of the private sector in health care, to ensure the sustainability of a universal and accessible network.
In its endeavour to protect the public by ensuring quality medicine, the Collège des médecins du Québec (CMQ) believes it must formulate guiding principles to ensure that access to care remains universal and equitable. A series of observations justifies this position on the role of public health care:
- Accessibility to health care and services is guaranteed by laws, regulations, and administrative rules, but is increasingly compromised;
- The provision of privately funded health care services is growing, even though evidence shows that this does not improve access to health care nor reduces costs to the network;
- The fundamental social contract between citizens, the state, and health care professionals, including physicians, is faltering, and social and individual responsibilities are being eroded.
The Collège relies on the following shared values to ensure that the provision of health care to the public is regulated by the government and professional orders:
- Mental and physical health are a fundamental right;
- Health care and services are a non-marketable collective asset;
- Legislation protects, promotes, and improves the physical and mental well-being of the population.
It follows that the sole purpose of private provision of care should be to support that of the public sector.
At its meeting last October 25, the Collège’s Board of Directors adopted the following guiding principles:
WHEREAS health is a fundamental right and health care services must be considered a common good that shall not be commercialized;
WHEREAS section 3 of the Canada Health Act states that the primary objective of Canadian health policy is to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers;
WHEREAS section 7 of this Act sets out the conditions that must be met by the provinces in order to receive the full cash contribution as part of the Canada Health Transfer (CHT), namely public administration, comprehensiveness, universality, portability, and accessibility;
WHEREAS in Quebec, legislative, regulatory, and administrative measures have been put in place to make health care services accessible to all citizens;
WHEREAS in recent years, the provision of privately financed health care services has undergone accelerated development, both in terms of services required and not required by the health status;
WHEREAS this phenomenon compromises equity of access to services in addition to calling into question the existing social contract between the state, citizens, and health care professionals, including physicians;
WHEREAS this contract is based on the values of justice and equity of Quebec society;
WHEREAS a significant portion of the government’s budget is allocated to financing the health and social services network;
WHEREAS the Collège believes that it is urgent for the government and Santé Québec to take all measures aimed at rapidly and significantly improving access to and the organization of services in the public network;
WHEREAS there is evidence to show that contrary to popular belief, private sector development does not improve access to health care or reduce the associated costs;
WHEREAS the Collège is of the opinion that all Quebec citizens must have access, without discrimination, to quality health care and social services based on the requirements of their health status, and this, within the appropriate time limits;
WHEREAS the College is convinced that the provision of health care services, both public and private, must be regulated by the government as well as by professional orders;
WHEREAS non-participating physicians are subject to the same ethical obligations as physicians practising in the public network, particularly those relating to management and follow-up obligations, especially in the event of complications;
WHEREAS the Collège considers that the private provision of services required by the state of health should aim solely to support that of the public network;
BE IT RESOLVED to adopt the following guiding principles:
The CMQ recommends a public and universal health and social services network that is accessible to all citizens, without discrimination, and within the timeframes appropriate to their state of health;
The CMQ calls for an immediate halt to the expansion of the private health care sector;
The CMQ is demanding that existing private care be rigorously regulated and supervised by the government, particularly with regard to the following elements:
- The difference in fees paid for the same service, between the public network and the private sector;
- The conditions and procedures for providing care and services in the private sector;
- The procedures for changing the status of a physician from participating to non-participating in the public network.
The CMQ believes that the financing of services offered by the private sector must remain totally public, with no additional outlay on the part of the patient;
The CMQ believes that third-party entities (legal entities) with which physicians may associate in the practice of their profession must be subject to a professional and legal framework;
The CMQ reiterates the importance of the social contract between physicians and society, which entails individual and collective responsibilities for all members of the profession, without exception.
The Collège will make the necessary representations to ensure that these guiding principles are taken into account by decision-making bodies in order to guarantee universal access, equity, and the sustainability of Quebec’s public health care network.