The New Healthcare

What is had news for health care fundamentalists is good news for the rest of us. Last year the Canadian Medical Association installed the dynamic Brian Day, a British Columbia orthopaedic surgeon and outspoken advocate of private sector medicine, as its president. His election was widely seen by adherents of the Canada Health Act as a vote of non-confidence in the country's public health care system. That message became even clearer last month as Dr. Day's successor, radiologist Robert Ouellet of Quebec, took the reins. Ouellet may be even more outspoken in favour of private sector health care than Day, and he comes from the province at the forefront of medicare reform.

As the former head of radiology at a Montreal-area hospital, Ouellet experienced firsthand the frustrations of an exclusively publicly funded system. In the 1980s he was told it would he a two-year wait before his hospital could buy a CT scanner. Instead of waiting, he bought the equipment privately and started providing tests immediately. He later added an MRI machine and eventually presided over a chain of five clinics. Ouellet's vision is of private sector investment complementing the public system to reduce wait times. "Shutting the door on private health care is the same as shutting the door on our patients," he told the CMA annual meeting in August.

Successfully renewing medicare will require broad acceptance of a bigger role for the private sector; and the CMA's endorsement of Day and Ouellet reflects this fact. But when and where will such a change occur? If Saskatchewan was the birthplace of Canada's existing health care system, it is Quebec that now looks to be giving birth to a new and sustainable hybrid approach.

The province's unique political position in Canada has provided it with greater scope to innovate in health care, albeit sometimes grudgingly. The 2005 Chaoulli Supreme Court ruling forced the province to permit citizens to buy private health insurance. Two recent and independent reviews of the provincial health care system were notable for their emphasis on a bigger role for the private sector, although these recommendations were mostly ignored by the Charest government. in February, the Castonguay Report pointed out that nearly every industrialized country in the world allows doctors to move back and forth between the public and private systems. Canada archaically forces doctors to choose one or the other, limiting the ability of the private system to relieve pressure on the public portion.

But Quebec has eagerly embraced innovation in many other instances. A new state-of-the-art hospital in Montreal is being built via public/private partnership. There will be provincial guarantees of wait times of no more than six to nine months for certain procedures. And Ouellet's own experience with private clinics proves the importance of integrating public and private systems. In perhaps the most intriguing development, the Quebec health minister who dutifully defended the status quo in the face of the Castonguay Report recently jumped ship himself to a private sector health care investment firm.

The logic of greater private sector involvement in Canadian health care is inescapable and inevitable. And Quebec is showing the way for the rest of us.