Subject: PRIVATISATION IN HEALTH CARE:_CANADA ORIGINAL NOTE: "Among others, I think the folks at the Canadian Centre for Policy Alternatives have been producing stuff on this, but I didn't find a specific title in my quick search at http://www.policyalternatives.ca/bc/index.html. The BC government has set up an agency to promote public-private partnerships in health delivery, e.g. they plan to open a new PPP hospital in Abbotsford, even though the accounting study commissioned projects "savings" of less than 3% (and this does not include lots of costs, e.g., for government planning). Bill AN ADDITION: 1) I had forgotten this earlier enquiry re the Swedish system. The notion that introduction of fees would "save" dollars overall - has been now discredited in Sweden, with the recognition there that in effect what happened was simply a shifting away from cost-effective preventative therapies, which leads to an impact later of serious (& expensive) health impacts. To those interested in critiquing the Swedish experience - it is worth also looking at the Australian system. The Ozzies went the British route of privatising increasing chunks of health care developed by the UK Social democrats (Labour Party) - & although it is too early to tell stats on health outcomes - there appears to be increasing public complaints. However, the following article is very interesting indeed: 2) The Canucks recently published an important meta-analaysis - led by members of the "Medical Reform Group (Ontario)" - in the CMAJ: CMAJ 2002 May 28;166(11):1399-406: ABSTRACT: A systematic review and metaanalysis of studies comparing mortality rates of private for-profit and private not-for-profit hospitals. Devereaux PJ, Choi PT, Lacchetti C, Weaver B, Schunemann HJ, Haines T, Lavis JN, Grant BJ, Haslam DR, Bhandari M, Sullivan T, Cook DJ, Walter SD, Meade M, Khan H, Bhatnagar N, Guyatt GH. Department of Medicine, McMaster University, Hamilton, Ont. [EMAIL PROTECTED] BACKGROUND: Canadians are engaged in an intense debate about the relative merits of private for-profit versus private not-for-profit health care delivery. To inform this debate, we undertook a systematic review and meta-analysis of studies comparing the mortality rates of private for-profit hospitals and those of private not-for-profit hospitals. METHODS: We identified studies through an electronic search of 11 bibliographical databases, our own files, consultation with experts, reference lists, PubMed and SciSearch. We masked the study results before determining study eligibility. Our eligibility criteria included observational studies or randomized controlled trials that compared private for-profit and private not-for-profit hospitals. We excluded studies that evaluated mortality rates in hospitals with a particular profit status that subsequently converted to the other profit status. For each study, we calculated a relative risk of mortality for private for-profit hospitals relative to private not-for-profit hospitals and pooled the studies of adult populations that included adjustment for potential confounders (e.g., teaching status, severity of illness) using a random effects model. RESULTS: Fifteen observational studies, involving more than 26 000 hospitals and 38 million patients, fulfilled the eligibility criteria. In the studies of adult populations, with adjustment for potential confounders, private for-profit hospitals were associated with an increased risk of death (relative risk [RR] 1.020, 95% confidence interval [CI] 1.003-1.038; p = 0.02). The one perinatal study with adjustment for potential confounders also showed an increased risk of death in private for-profit hospitals (RR 1.095, 95% CI 1.050-1.141; p < 0.0001). INTERPRETATION: Our meta-analysis suggests that private for-profit ownership of hospitals, in comparison with private not-for-profit ownership, results in a higher risk of death for patients. PMID: 12054406 [PubMed - in process] "
3) Currently in the Canadian system, the Third health care reform enquiry is being conducted by Roy Romanov - an ex-NDP (Social democrat). It appears that out he is likely to report on whether - in essence - more public - or more private - $$$'s need to go into health care. I myself do not remain sanguine that indeed he will recommend better more public $$. Stay tuned. Hari Kumar
