Dr. Brian Day @DrBrianDay

As good as Canada’s health care system has been, critical decisions have to be made to deal with the significant challenges facing it. The status quo is no longer sustainable. Reinforcing myths and repeating platitudes about private and public health care have created policy gridlock and it is patients who are suffering. Policymakers have not been proactive on health policy, and the courts have been forced to act.

This paper was prepared to contribute to an informed debate on the appropriate role of public and private sectors in health care. We have explored the public–private interface in Canada and abroad and identified key issues and policy principles to guide decision-making in this area.

As we move forward, we need to be cognizant of the following key messages.

1. It’s about access: Canadians remain very concerned about the decrease in access to timely care at several levels beginning with access to a family physician. Although recent targeted efforts to bring down wait times are a step in the right direction, there is an urgent need to define performance benchmarks and improve timely access to services across the system.
   
   
2. Things are not as simple and clear as we might want them to be: The public–private mix in health care is complex due to the various arrangements in which care can be financed and delivered. The diverse combinations of funding and delivery currently in use and being contemplated are blurring the way we
   have traditionally categorized public and private elements in the health care system.
   
   
3. Think outside the box: A review of public–private funding and delivery options in other countries reveals that there is no single best way to fund and deliver health care to citizens. Indeed, a wide range of policy approaches is in place in OECD countries and across the 13 provincial and territorial health care systems. As in Quebec and Alberta, we can expect to see more policy options emerging in the months ahead.
   
   
4. Keep a broad perspective: Rethinking the public–private interface is just one of several strategies to improve access to timely care for Canadians. Preventing illness and addressing Canada’s shortage of health care professionals and infrastructure gaps are also key to improving access.
   
   
5. Making policy choices is both challenging and rewarding: Trade-offs are required in choosing among competing policy options. To best meet the objective of access to timely care based on need, citizens and other stakeholders, including physicians, will have to select a balance of public–private interface options that involve a level of trade-offs that they can accept.