Canada's doctors are calling on governments and health authorities to embrace "internal market mechanisms" that promote competition between health-care institutions and offer financial incentives for prompt, quality patient care.
"Competition is a fundamental motivator of people. ... It works," said Eric Wasylenko, a physician from Okotoks, Alta., who proposed the motion yesterday at the Canadian Medical Association general council meeting.
But opponents say the approach will lead to patients being mere commodities, with providers competing to nab healthy "profitable" patients and "unprofitable" ones such as seniors with numerous chronic illnesses being abandoned to depleted public programs.
"An internal market is not the kind of reform that would help our patients," said Irfan Dhalla, a Toronto physician.
The measures could include activity-based funding (instead of giving hospitals a set budget, funding would be tied to the number and type of patients they see), contracting out surgical procedures to private clinics, pay-for-performance measures that would reward doctors and administrators who meet targets, and publishing hospital infection rates then rewarding the best performers.
After a spirited debate, 85 per cent of delegates backed the motion to "examine internal market mechanisms, which could include a role for the private sector." In doing so, they endorsed one of the key pillars of the fundamental transformation that is being proposed by the CMA's leadership.
CMA delegates also called for governments to bolster the availability of spots in long-term-care facilities, speed up the implementation of electronic health records and consider "timely access" as a key element when measuring the quality of care.
"Wait times should not be the price to pay for universal health care," Robert Ouellet, the outgoing CMA president, said yesterday in his valedictory address.
Dr. Ouellet, a vocal proponent of measures such as activity-based funding and pay-for-performance contracting out to the private sector, said they are examples of the type of innovation that is required and stressed that these "changes are possible to the system without compromising universality."
He said changing how the system is funded is the essential first step to improve access and quality of care for patients, and noted that many provinces are already moving ahead with changes. Quebec, for example, has new legislation that will see 56 surgical procedures contracted out to private clinics and paid for by the provincial health insurance program. And the CEO of Alberta Health, Stephen Duckett, said this week that the province plans to introduce activity-based funding for hospitals in 2010.
Dr. Ouellet told delegates that tinkering is no longer enough and sweeping change is required.
"It may be comforting to think that we can keep working within the current system, maintaining our old ways of doing things, our old habits and our old attitudes. But that ignores the high price to be paid for the status quo.
"If we keep doing the same things, we will have the same results. Refusing to make profound changes to the health-care system is tantamount to accepting its steady deterioration," Dr. Ouellet said.
Robert Woollard, vice-chair of Canadian Doctors for Medicare, said that while the CMA president talks a good game, the basic premise of his argument is false.
"It's a classic form of rhetoric to cast your opponents as defending the status quo," he said.
"But the status quo ain't what it used to be. There is a lot of change happening within the public system and that should continue."
Dr. Woollard said that physicians, in looking to reform the system, should be guided by evidence and the evidence is that "internal market mechanisms" benefit few and disadvantage many.
"If you throw it open to the market system, a lot of patients will be pushed aside," he said.
Those disparate views are reflected in a poll commissioned by the CMA. The survey found 83 per cent of doctors believe there is an "urgent" need to fix Canadian health care. However, they are split on whether a fundamental transformation of the system is required.
