British to Canadian Doctors: Collaboration not market competition is the remedy for health care

    OTTAWA, Aug. 16 /CNW Telbec/ - Canadian doctors, members of the Canadian
Medical Association, will be meeting in Vancouver next week from August 19 to
22. On the agenda for resolutions and discussion will be activity-based
funding, a system that proposes to finance health care according to volume and
type of service instead of via global funding, as is the current situation.
    A letter from British doctors to the Canadian Medical Association (CMA),
the second of its kind, raises serious questions and advises Canadian
counterparts of the pitfalls inherent in a number of proposals for
    In the letter, Dr. Jacky Davis and Dr. Peter Fisher, executive officers
with Britain's National Health Service Consultants Association (NHSCA), advise
members of the CMA to beware of the fantasy fixes suggested by privatization.
Dr. Davis' letter makes it clear that the romance with privatization in Great
Britain's health care system is over. Both the newly appointed Minister of
Health and the governments of Scotland and Wales have called for a serious
reduction and even an end to the privatization of services. The British
Medical Association also opposes the competition model.
    Dr. Davis and Dr. Fisher write, "Those in support of privatization often
cite the 'English Experiment' as proof that the private sector can "save"
public health care. They point to significant reductions in waitlists since
the reforms were established. However, that is hardly surprising given that
health spending has more that doubled since 1997. The reality is that money
has been lavished on politically sensitive wait lists for elective surgery
through expensive and unsustainable deals with the private sector. This has
been to the detriment of many patients with more long term needs."
    Dr. Davis and Dr. Fisher indicate that doctors, including members of the
British Medical Association, and politicians throughout Great Britain, are
becoming weary of solutions that result in higher costs and increasingly
limited access to services.
    When it comes to "performance-based funding, known in Britain as
performance-by-results (PbR), Dr. Davis and Dr. Fisher are unequivocal: "This
shift (to payment by results) - begun three years ago - has resulted in so
many perverse incentives and unintended consequences that its future is now in
doubt. One downside particularly relevant to you (Canadian doctors) is the
fact that PbR may lead to unnecessary admissions."
    Examples of activity-based funding initiatives already exist in B.C. and
Ontario. The B.C. government's new $16.4 million performance-based hospital
funding pilot project uses a commercially-inspired incentive system to achieve
outcomes that could be achieved with a global budget and a democratic,
evidence-based decision making process - one that uses less overhead. The
$1 billion Ontario Wait Times Strategy is also a concern because it prices
procedures, rewards competition between facilities, and favours specialized
    The current leadership of the CMA is advocating more, not less, private
sector involvement in Canada's health care system. Specifically, the recent
CMA policy paper titled Medicare Plus recommends that government allow
Canadians to purchase private health insurance and allow doctors to practice
in both the public and private system. It also urges governments to consider
funding private sector health services.
    The British experience should tell Canadian doctors and Canadians that
strong public policy providing for stable funding and collaboration, not
marketing miracles and private investment, are needed to move Canada's health
care system forward.
    "We must conclude," says the British doctors' letter, "that neither
payment by results, the increased use of the private sector or the 'patient
choice' agenda have proved their worth. On the contrary, they have resulted in
a destabilized and damaged public service. The government has sought to
introduce a set of policies for which there is no evidence, policies which are
incoherent and contradictory. These policies have fragmented health care,
discouraged collaboration between healthcare professionals, and wasted money.
This is why patients, the public and healthcare workers are seriously

    The full letter can be read or downloaded at

    The National Health Service Consultants' Association represents
650 British specialists in a broad range of practices. Visit for more on the NHSCA.

    CUPE is Canada's largest union. There are over 170,000 CUPE members
working in hospitals, long-term care facilities, continuing care, home care,
community clinics, public health units, emergency medical services, and
diagnostic services across the country. They work as cleaners, care aides,
licensed practical nurses, technicians and in many other jobs throughout the
health care system.

For further information:

For further information: Claude Généreux, CUPE National
Secretary-Treasurer, (613) 237-1590 ext. 201, (514) 884-5074 (cell); Stan
Marshall, Managing Director, CUPE National Services, (613) 237-1590 ext. 228,
(613) 286-6568 (cell);

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