On January 18, the Hart House Student Debate & Dialogue Committee hosted Dr. Shoo K Lee — honorary staff pediatrician at Mount Sinai Hospital and founder of the Canadian Neonatal Network, a group of Canadian researchers focusing on neonatal care — for a presentation titled “Private vs Public Healthcare — Improving the Quality of Care in Canada.”
During his talk, he focused on two key problems with the Canadian health-care system as experienced by the public: health-care access and wait times. These issues are experienced by individuals in the long search for a family physician or those without a family physician, as well as those who experience long queues at emergency rooms or prolonged waits for available specialists, which can only worsen the anxiety and pain that a patient might be feeling. But while accessibility and wait times are a concern, Lee mentioned that 75 per cent of patients surveyed are happy with the care they receive.
Privatization of health care
While discussing health-care access, Lee made an argument regarding the privatization of medicine. He explained that whether a country decides on a private versus a public health-care system depends on the types of values by which they want their system to run. If a system is entirely private, then rich individuals will be able to purchase all the health care that their money can buy, while those who are poor will be faced with increasingly inadequate access to health care. This system does work in theory, despite increasing health inequity, but it does not operate based on the values that we want our society to live by.
As it stands, Canada’s health-care system is not entirely public, as 30 per cent of it is made up of privatized services, including drugs, dental care, vision care, and physiotherapy. These services are not covered by government insurance, and therefore not deemed medically necessary.
For mental health, meanwhile, while some clinics, centres, hospitals, or associations are government funded, the majority of Canadian health-care plans do not cover registered psychologists or social workers in private practice, which puts up an accessibility barrier for those seeking support.
But what are the values by which we should run the Canadian health-care system?
The values of Canadian health care
Lee states that the five key principles of the Canada Health Act — a statute of the Parliament of Canada that establishes the objectives of health care in Canada — are Universality, Comprehensiveness, Portability, Public Administration, and Accessibility. According to an analysis comparing the health-care systems of numerous countries, the more public the health-care system is, the more these principles are met, and there were no exceptions to this analysis. While these values are better upheld in a public health-care system, the health outcomes of a particular country are not dependent on whether or not the health-care system of that country is public or private, but instead the socioeconomic status of that country.
To address these concerns, Lee proposed that instead of making a decision regarding private versus public health care, we should first tackle the underlying structure of systems in place. One such area of focus should be political will. Risk-averse politicians are an issue because these politicians will not propose change unless they are guaranteed public support.
When it comes to the lack of access and lengthy wait times, Lee spoke about the shortage of doctors and nurses contributing to the issue, and explained the fluctuation of seats in Canadian Medical schools, indicating a 38 per cent increase in the past 20 years. But instead of forcing doctors and nurses to work longer — and potentially unhealthy — hours, a systemic solution would be to increase the number of students being trained in the health-care field to compensate for the work-life balance movement.
Overall, Lee stressed the importance of not trying to fix the issues within our system with band-aid solutions that do not approach the issues holistically. By focusing on the system as a whole, we can ensure sustainable solutions that will prevent these issues from reappearing and worsening.