Greater competition, better regulation, among needed solutions

HALIFAX — The Atlantic Institute for Market Studies (AIMS) today released its most recent report on the state of Canada’s health care system entitled, “Public Health, State Secret”. The study demonstrates that politicians and senior health officials simply don’t know where or why medicare is failing because they still lack the proper tools to evaluate the quality or timeliness of the care Canadians receive. More to the point, the authors demonstrate why, under the current system, it is not in the government’s interests to know what is really happening in health care.

“Governments that simultaneously act as the insurer, service provider, and evaluator of health care quality, are in a conflict of interest,” says report co-author Dr. David Zitner, Director of Medical Informatics at Dalhousie University. “If they collect and provide clear and easily understandable information about the system’s performance, the public and health care professionals will use that information to criticize them and hold them accountable for poor performance.”

This conflict of interest serves to perpetuate a system that functions as an unregulated monopoly, with no defined performance standards for the quality and timeliness of the services it provides. The result is declining standards of care, closures of hospital beds, lengthening waiting times, labour disputes, and shortages of skilled labour.

“The current health care system is missing the basic information essential to its proper management and improvement,” says Zitner. “Basically, reform proposals are whistling in the dark with no clear evidence to indicate what is wrong or what can be done to fix it.”

The report authors, Dr. David Zitner, AIMS Fellow in Health Care Policy, and Brian Lee Crowley, AIMS President, have done several previous works in healthcare and are actively involved in its reform. Crowley is a member of the Alberta Premier’s Advisory Council on Health chaired by former Deputy Prime Minister Don Mazankowski. Public Health, State Secret more fully explores some of the themes and arguments that are presented in the recently released report of the Advisory Council, A Framework for Reform.

Crowley and Zitner suggest that successful reform of the health care system, including the gathering and dissemination of all the appropriate information, requires the addition of a greater degree of competition and the improvement of the regulatory framework. These needed remedies can be injected into the system by “unbundling” the functions that governments now play in the health care system.

Unbundling the functions will improve incentives to collect information and make it widely available, allow consumers to hold providers of health care services accountable by abandoning those with unacceptable waiting times or treatment outcomes, and allow governments to exercise a more vigorous and demanding standard of regulatory oversight.

Copies of Public Health, State Secret, or other AIMS’ publications are available on-line at or can be obtained by contact the AIMS offices at 902-429-1143 or [email protected]


For further information, contact:
Dr. Brian Lee Crowley, President, AIMS, 902-499-1998
Dr. David Zitner, AIMS Fellow in Health Policy, 902-494-3802