Major health care organizations, including the CMA, say there is strong support for having medicare continue to fund core medical and health services in traditional settings. But preliminary results from a survey of more than 10 000 representatives of health and business organizations indicate there is little support for extending public funding to alternative therapies or medical and surgical services delivered in private clinics.
Initial results of the collaborative survey, based on the first 1560 responses, were presented in Halifax May 23 at the annual meeting of the Canadian Health Economics Research Association. The study was conducted by the University of Toronto-based Medicare to Home and Community Research Centre.
In addition to leaders from organizations such as the CMA, key representatives from small and big businesses were polled about which of 48 services should be funded by medicare. Support was strongest for those provided in MDs' offices and through day surgery — services already covered by medicare.
The survey asked whether each service should be fully funded, funded only for those unable to pay, subject to a user fee or funded by the user. There was little support for extending pubic funding to alternative or complementary therapies, chiropractic, in-vitro fertilization or travel vaccinations. Support for extending public funding to services delivered in private clinics or other nontraditional settings was also limited.
Study coauthor Raisa Deber said the latter finding was “frankly, surprising,” and speculated that it might reflect opposition to any privatization within the existing system. Deber, a professor of health economics at the U of T, said the findings indicate the importance of the Canada Health Act in determining which services are publicly funded and suggested that the items currently funded appear to represent “a ceiling rather than a floor.” Deber also said the survey is important because it represents “an awfully elite sample ... people who are supposedly the most informed about the debate [about what to fund].” Final results will be posted at www.m-thac.org. — Pat Rich, CMAJ