Beyond mythology
================

* Michel Tremblay

As quoted by Loreen Pindera,1 Senator Michael Kirby is right that it is a “great myth of Canadian public life” that the Canada Health Act prohibits private delivery of health services.

Having worked in the United Kingdom (and now returning to Canada), I may have some relevant observations. The UK's National Health Service (NHS) is embracing Kirby's “provider agnosticism,” making the NHS more an organizing principle than a state-owned and run health service.

New private NHS providers (including some from Canada) have targeted areas where clinical procedures can be done quickly and efficiently and where patient demand is high (and waiting times long) at prices the Department of Health is prepared to afford.

A key emerging lesson for Canada can be found in the UK priority on “public choice” and provider plurality in providing public services, which gives users greater choice in how and when they access these services — thus focusing on what the citizen-user wants, not what the service providers want. This “disruptive” idea will reshape services in the image of higher public acceptability and quality not otherwise obtainable through heavy-handed methods. It is hard to imagine a system without such incentives being worth funding in the first place.

That there is a whole Europe full of countries with high standards of care delivered in complex combinations of public and private ownership should make critics of private providers pause to reflect on the certainty of their position. The opportunities to improve health care for Canadians through a more flexible and open system will be lost unless we can move beyond the myths. Reform starts with understanding reality, not hiding from it.

## Footnotes

*   *Competing interests:* Dr. Tremblay conducts policy research and consultancy for governments and private companies in the health sector.

## Reference

1.  1. Pindera L. Increasing private delivery of publicly funded services? CMAJ 2005;172(2):167.
    
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