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Editorial:
The two-step to two-tier
CMAJ 2004; 171: 541 [Full text] [PDF]
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[Read eLetter] Are Private Emergency Clinics Effective?
Joseph Erban   (27 September 2004)

Are Private Emergency Clinics Effective? 27 September 2004
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Joseph Erban
Jewish General Hospital

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Re: Are Private Emergency Clinics Effective?

jerban{at}sympatico.ca Joseph Erban

The recent announcement in Quebec of the opening of a first private emergency medical clinic poses a dilemma.

Some would argue that a privately funded emergency clinic would result in timely care to those in need of urgent medical care, and who would otherwise not receive as prompt care if they were to attend our publicly funded emergency rooms. The fact that someone pays for healthcare needs is already in place, as 30% of medical expenditure is privately funded through out of pocket. Those who can afford to pay for privately managed emergency clinics have the fundamental right to do so.

On the other side are those who claim that there are uncertainties in privatizing emergency services. They claim that this could lead to a slippery slop of a two-tier healthcare system--one for the rich and another for the poor. Should we allow for private emergency clinics to mushroom, a decline of public healthcare professionals would ensue to the point where there would be under-staffed and overwhelmed healthcare providers for the publicly funded healthcare system, while those who can afford private clinics will receive well-staffed and prompt care.

Moreover, since private clinics would not offer all emergency services--given their potentially limited mandate--they may require the use of publicly funded institutions for additional interventions which they would not comprehensively provide. Therefore, even though the entire population pays for such public services, private clinics indirectly benefit from them, but at what if any cost to them?

The question introduces, I believe, the more salient issue recently mentioned by CMAJ, namely, the need to evaluate medical interventions for their efficacy.

The opening of a private emergency medical clinic points to the need for greater public consultation and debate about the value of equity, and the need for evidence-based evaluation of new interventions.

Joseph Erban Member, Clinical Ethics Committee Jewish General Hospital

Conflict of Interest:

None declared