Competition in the delivery of many health services would improve efficiency and quality
Yes, said Mr. Michel Clair, President and CEO of Groupe Sedna, Québec's largest private not-for-profit long-term care provider.
I believe more private delivery would improve health care. The delivery of health care services is not an integral part of our social values.
Actual competition in the delivery of many services would create a very positive systemic stress on public delivery to improve efficiency. No centralized management or monopoly, no matter how good, can do better than competition to increase the productivity and efficiency of a huge economic sector like health care delivery.
Introducing more private delivery would be one way to improve the system’s capacity to measure whether producers — be they public, not-for-profit or for-profit — are meeting cost and quality criteria. Private enterprises are accustomed to quality control, financial and operational control. Transparency and good governance in the private sector is based on those specific values.
More private delivery would give a new impulse to innovation, because private companies regard innovation as a means to increase profit. The potential for innovation is huge in our system, but implementing research results, be they clinical, technological or administrative, is always an enormous challenge within a monopoly. For the private sector, introducing the latest research findings is a matter of survival and competitiveness.
Private delivery, embedded in the Canadian health care system as an essential partner pursuing the same general goals and the public interest, could act as a powerful lever to prevent the rise of a parallel private system for rich people.
There are a large number of high volume areas, either for diagnostics or surgery, that could take advantage of the private sector’s capacity to provide high quality and high efficiency low cost services. It is a strategy to harness private energy towards public interests instead of ignoring it and letting it build a privately funded competitive parallel system.
More private delivery would bring changes to budgeting rules. No Ministry would ever fund a private company on a historical basis. Private delivery would therefore ensure the introduction of cost-per-unit budgeting systems. Citizens would have greater choice of providers, who would be paid by a public purchaser on exactly the same basis as public providers. That would create tremendous momentum in the system to start providing rapid and easy access to services, instead of managing waiting lists.
In conclusion, more private delivery of publicly funded services is a tremendous opportunity to improve the productivity of our health care system as a whole. Private delivery is both good in itself, and it would be good to the system as a whole. It would mobilize the energies of private investors and managers to modernize our delivery system in pursuit of public interest goals. It would also improve the quality of services, the pace of innovation, and produce efficiency and easy access to services. To make more private delivery possible, we need to put an end to the confusion between delivery and funding and start regarding private delivery as an essential partner in the modernization of our system, instead of just a money-making pursuit.
About Michel Clair
Michel Clair was a member of the National Assembly of Québec from 1976 to 1985, serving as Minister of Revenue, Minister of Transport and Minister of Natural Resources, among other responsibilities. In 2000, Mr. Clair became Chair of the Commission on Health and Social Services, which submitted its report to government in 2001. He assumed his current role as President and CEO of Groupe Sedna in 2001. The company specializes in the delivery of health services through its affiliates, largely in partnership with Québec's public health care system.