Public-private partnerships

Issue: BCMJ, vol. 43, No. 10, December 2001, Pages 548-549 Editorials

At virtually the same moment, every government across Canada has apparently come to the same startling revelation: that publicly funded medical care needs private partnerships in order to survive. Doctors, medical editorialists, demographers, and some demonic, ultraconservative think-tank, right-wing types have been shouting the same message for the past decade. Until now their message has been effectively drowned out by an energetic group of Canada’s politicians, health bureaucrats, and health economists, all seemingly possessed with an uncommon facility to obfuscate.

Now that there appears to be a political will to investigate the potential of private partnerships in medical care, every politician looking up at the next rung on the political ladder is going to be heard from and almost certainly is going to let his or her constituents (most of whom are now clamoring for this) know that it was his or her idea. I shouldn’t be feeling negative about this, I suppose, because even though this all seems to be happening at 11:59 p.m. on the Medicare Armageddon Clock, the actual implosion of the system, theoretically at least, can be averted by some sweeping changes—only one of which includes partnering with private business.

It is also heartening to see that decision-makers in the medical-political business have decided to include doctors in the decision-making process, but I have to wonder at the mindset of those bright lights in Ottawa who thought creating yet another royal commission looking into the viability of medicare was a stellar idea. Unfortunately, some of the individuals belonging to the commission’s core group seem to bring some weighty political ideology to the table. One apparently believes that medicare is not in crisis and doesn’t mind articulating that in front of the cameras. I just wonder what would define a crisis in medicare? These people are currently spending millions of our tax dollars (latest estimate $15 million) to take a close look at a system that physicians know has gone way beyond crisis to the very edge of complete collapse—yet seem permanently stuck in the brain-glue of political rhetoric whenever asked about possible alternatives to a purely publicly funded system.

The likelihood is that our legislators will now throw the weight of government behind an initiative to save medicare in some form. Irrespective of what Mr Romanow eventually says in his report, medicare will likely be substantively different from what most of us have known for all of our professional lives. I know in my heart this will be a positive thing as long as the planning that is done in some way includes a business model along with all the other necessary bits and pieces of the equation.

Finally, there is going to be a 6- to 10-year time lag before any of these dramatic and possibly drastic changes improve the lot of our patients. In the meantime, our elected representatives are going to have to come up with a plan that will make the practice of medicine attractive enough to convince the about-to-retire docs to change their collective minds and keep their doors open. This group, along with a perhaps more important group of new graduates, are going to have to be convinced it is a valuable decision to decide to stay and work in BC and yes, uncle Bob, when I say valuable that means society is going to have to show that it values these people and pay them more money. The concept of paying doctors what they are worth apparently is anathema within the box none of the medical economists seem to be able to think outside of.


James A. Wilson, MD. Public-private partnerships. BCMJ, Vol. 43, No. 10, December, 2001, Page(s) 548-549 - Editorials.

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