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10 J. Consumer Pol'y 1 (1987)

handle is hein.journals/jrncpy10 and id is 1 raw text is: Pran Manga
Privatization of Health Care Services in Canada:
Reform or Regress?
ABSTRACT. The emergence of the privatization of health care services as one of the
dominant health policy issues in many western industrialized countries is no doubt related
to a number of factors, including rising health care costs, fiscal crisis in the form of
budgetary deficits, charges of public waste and mismanagement and underfunding, the
onset of a new era of political and fiscal conservatism, and professional and corporate
antipathy to certain aspects of publicly financed health insurance schemes.
The paper discusses the meaning of privatization and stresses the importance of
recognizing the different forms of privatization and the need to assess these forms against
well specified health policy objectives. Current and proposed forms of privatization in
Canada are described and evaluated.
It is concluded that there are sound arguments against privatization through user fees
for insured physician and hospital services. As for the other forms of privatization there
are confusing and inconsistent findings that preclude a definitive conclusion as to the
wisdom of a general push for privatization. It is stressed that there are not many
empirically established facts about the likely effects of privatization and the many claims
about the virtues of privatization are far from substantiated by careful research. In the
absence of such evidence the push for reprivatization seems, as some critics have pointed
out, ideologically motivated.
Judging from the burgeoning literature, the numerous symposia and
conferences devoted to the issue, pronouncements by government officials
and politicians, privatization of health care services is apparently one of
the dominant health policy issues in virtually all of the western industrial-
ized countries. This is both a curious and unfortunate development. The
privatization issue has diverted public and professional attention away
from far more important matters. These include the inequalities in access
to hospital and medical services, the inefficiencies in the production of
these services, the questionable effectiveness and efficacy of medical
technology both old and new, the looming oversupply of physicians which
co-exists with a geographic and specialty maldistribution of doctors, the
overwhelmingly curative bias of the health care system to the neglect of
primary and public health services, the perverse incentive systems for
providers characterized by the reliance on fee-for-service method of
reimbursing physicians, the massive misuse of human resources especially
the non-medical professions, and last but not least, the tenuous relation-
ship between health care services and health. It is frequently argued that
privatization is indeed a solution to one of the above mentioned problems,
specifically, the inefficiency of our health care delivery system, but

Journal of Consumer Policy 10 (1987) 1-24.
© 1987 by D. Reidel Publishing Company.

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