Competition surest route to top quality health care

By Rory Leishman

Dr. P. J. Devereaux of McMaster University and 16 co-authors have created quite a fuss with an article in the current issue of the Journal of the Canadian Medical Association, in which they contend the risk of death is two percent higher in private, for-profit hospitals than in private, non-profit hospitals in the United States. If that’s true, it’s difficult to explain how most private, for-profit hospitals, which comprise about 13 per cent of all hospitals in the United States, can stay in business.

Regardless, a matter of more vital interest to Canadians is the performance of our own hospitals. How do they stand up in comparison with each other as well as their private, for-profit and non-profit counterparts in the United States?

Dr. William Orovan, a past president of the Ontario Medical Association, maintains Canadian hospitals are not doing at all well. In a recently televised panel discussion, he cited unacceptable waiting lists for many hospital-based treatments in Canada. Another panelist, Carol Kushner, a health consultant and author, immediately accused him of baseless fear mongering on the ground that the data on hospital waiting lists in Canada are unreliable.

In an informative collection of readings entitled, Better Medicine: Reforming Canadian Health Care, Dr. David Gratzer has included the transcript of an interview in which he asked Orovan how he would respond to Kushner’s accusation.

“Well, she’s right that the data is not complete,” Orovan conceded. “For hospital-based care, we don’t keep good statistics. In general, operating room waiting times, for instance, are not known because we don’t require that surgeons put in their list until seven days in advance.”

Nonetheless, Orovan insisted there is plenty of anecdotal evidence to indicate “a very major problem in diagnostic imaging and numerous interventional procedures.” He cited a two-fold increase in the CT scan waiting list over the last three years and a “huge waiting list” for cataract removal surgery at his own hospital.

In the latest edition of Waiting Your Turn: Hospital Waiting Lists in Canada, the Fraser Institute estimates waiting times for 121 different kinds of medical procedures. According to this study, most patients had to wait for treatment longer than what medical specialists regard as “reasonable” in 86 per cent of these categories.

However, the reliability of these data has also been questioned inasmuch as they are based on a survey of physicians rather than on a compilation of the precise times recorded in the medical files for each patient.

In the U.S., most state health departments make a wide range of information from medical files available in summary form for the guidance of experts and the public. In New York state, for example, a patient who has been advised to undergo dangerous surgery can readily determine which hospitals and surgeons in the state have the most experience in performing the operation (see

No such information is available to the public anywhere in Canada. In an essay in Gratzer’s book, Public System, State Secret, David Zitner and Brian Lee Crowley note that no one in any province can provide a satisfactory answer to such basic questions as: “How many people have difficulty finding a family doctor? Who got better, who got worse and whose health status remained unchanged as the result of contact with the health-care system? Which specialities have unacceptably long waiting periods?”

The problem, Zitner and Crowley explain, is that in Canada, “health care is an unregulated monopoly, devoid of any performance requirements.” The bureaucrats who run the system have a vested interest in keeping the rest of us in the dark about how well or poorly they are doing.

In contrast, medicare in the United States is a hotly competitive industry. Rival providers of medical services vie with each other to prove they can provide patients with excellent treatment at an acceptable price.

For Canadians, the conclusion is obvious: There can be no hope for any significant improvement in medicare until Canada, like every other democracy, opens up its public-sector medicare system to vigorous and across-the-board competition from service providers in the private sector.

Rory Leishman is a freelance writer based in London.Write Rory at The London Free Press, P.O. Box 2280, London, Ont. N6A 4G1 or fax 519-667-4528.