Tuesday, October 15, 2002
Medical Post

Conflicting interests

By David Zitner

There is something odd about government being both the sole legal provider and the regulator of health care

Canadians strongly value and appreciate many government activities. Perhaps this is the reason Canadians don’t resist too much when asked to pay high taxes. But there is a conflict of interest in Canadian health care that provides good reason to squirm.

Canadians appreciate government’s role as a public health-care insurer and administrator. Public administration of health care is one of the five principles of the Canada Health Act. The other four principles, spoken in hushed tones and largely ignored by government regulators, are:

accessibility (but many people face unacceptable waits);
comprehensiveness (the menu of covered services is not clear);
universality (federal workers and Workers Compensation patients have preferred access); and
portability (but the menu of services differs from province to province).
Canadians also appreciate government’s role in developing effective rules and regulations. We accept and welcome rules. We expect proper regulation, especially of monopoly industries. Most people welcome automobile safety inspection and compulsory seat-belt use, and are happy to have regulations applied to the automobile insurance industry, especially those rules insisting on appropriate and rapid claims settlement. Even the CBC is subject to regulation.

Canadians buying supplementary health insurance would be disappointed if a health insurer and drug factory owner told them it would take 12 to 15 months to fill a prescription.

The sadness would be even more if the delayed treatment had an important influence on one’s ability to function. We would be especially irritated if government agreed with the insurer and said delayed insurance settlement is fine.

Yet, this is exactly what Canadians tolerate (and sometimes expect) from our universal and compulsory health-care system.

Physicians and patients accept, and even expect, excessive waiting times for many appointments or procedures. Our monopoly health insurer (government) has imposed hurdles and line-ups for many expensive treatments including certain drugs. Within our largely public system of universal health insurance, a select group of government and other employees have preferred access.

Governments have been abysmal failures at regulating public health insurance. There are no rules for timely claims settlement or even a well-defined menu of covered services.

This is not surprising! For public health-care insurance the regulator (government) is not only expected to examine its own performance but also to bear the full cost of regulatory compliance. Health care in Canada functions as an unregulated monopoly. The monopolist is the regulator. When government as regulator applies rules to health care, government as insurer must bear the full cost of regulatory compliance.

At the CMA meeting in New Brunswick, Health Minister Anne McLellan suggested Roy Romanow would be best able to comment on the following questions. This is what I’d ask:

“Mr. Romanow, in your opinion, with regard to health care, is it appropriate to ask governments to evaluate and regulate their own performance? Or, do you agree with those who suggest it is a conflict of interest for government to do both? If you agree there is a serious conflict of interest, will you strongly support the Canadian Medical Association’s recommendation that Canada develop a permanent health-care commission independent of government?”

It will be interesting to see what kind of answer we get in November.