CMA's direction on the public–private interface
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“Mixed messages.” That was the media's mantra in its coverage of the CMA General Council debate in August. During the sessions on “It's about Access: the Funding & Delivery of Health Care” seemingly contradictory resolutions were approved by the 248 delegates. Here are some of the resolutions that will direct CMA in the next year.

## Support for the publicly funded system (change from within)

• Advocate for a publicly funded “safety valve” so patients who wait too long can get treatment elsewhere (97% in favour)

• Establish “pan-Canadian medically determined wait-time benchmarks for all major diagnostic, therapeutic, surgical and emergency services by Dec. 31, 2007” (88% in favour)

• Develop recommendations that acknowledge the strengths in the system and identify needed reforms (69% in favour)

• Call on the Canadian Institute for Health Information to report on the comparability of Canadian's access to medically necessary health services across the provinces and territories (98% in favour)

• Promote awareness and adoption of the wait time code as set out in the final report of the Wait Time Alliance (97% in favour)

## Support for more private funding

• Ensure that “any increase in private delivery and/or funding of health care will maintain the quality and availability of training experiences and placements for medical trainees” (96% in favour)

• Encourage “governments to include public–private delivery mechanisms to expand system capacity, with regulation to evaluate quality and cost-effectiveness” (91% in favour)

• Advocate to remove “existing bans that prevent physicians from practising in both the private and public sectors where such a restriction exists” (80% in favour)

• Advocate that “any proposals that introduce a private funding option for the delivery of publicly insured services allow for flexible practice arrangements (89% in favour)

• “Urge governments to allow physicians to have choice with respect to their practice environments, including the right to opt out of the public health care insurance program, provided that patient access to publicly funded care is not compromised” (87% in favour)

• Urge governments and health authorities that enter into public–private partnerships, to do so in an open and transparent tendering process (95% in favour)

• Develop a code of conduct for doctors providing services that are “publicly and privately delivered and/or funded, balancing professional autonomy and social responsibility” (87% in favour)

## Support both public and private

• Advocate for “timely access to the comprehensive spectrum of medically necessary care” by developing a policy framework that includes a “national human resources plan, national wait-time benchmarks, a patient wait-time guarantee supported by a publicly funded safety valve; and a regulatory regime to best support the public–private interface” (97% in favour)

• Advocate for using the “CMA's 10 Principles for the Future of Health Care” as a framework to assess proposals intended to enhance timely access” (5 of these principles include public–private funding) (97% in favour)

• Work with student organizations to organize tours of medical faculties to discuss with students the private-public interface, health care funding and delivery issues ( 77% in favour)

## Defeated motions

• “Urge governments to recognize that parallel private health insurance for medically necessary physician and hospital services is inconsistent with the principle that access to medical care must be based on need and not ability to pay” (38%–61%)

• “Re-examine the establishment of health insurance services in Canada that could lead to the provision of private, parallel, regulated, non-for-profit health care in Canada” (36%–63%) — Compiled by Barbara Sibbald, *CMAJ*