Let's defend the public health system at all costs
- Nazila Bettache
- Mar 23
- 2 min read
Nazila Bettache, Doctor at the University of Montreal Hospital Centre
Posted on March 16
"Does the private sector contribute to access to care or does it deprive the public health network of human and financial resources?" As the private sector takes up more and more space within our public health system, we are challenged by this question and its major impact. The next edition of the Rendez-vous du Collège des médecins du Québec [1], which will be held on March 17, will attempt to answer it.
First, a few observations are in order. The role of the private sector in healthcare is neither a "new thing" nor an "innovation." Remember that a private healthcare system was the norm before the creation of health insurance in the 1970s, itself a victory following major social struggles. Yet, the private sector has never disappeared, accounting for 27% of healthcare spending in Quebec in 2022.
Indeed, despite a so-called "universal" system, health professionals (psychologists, dentists, etc.), although essential, work mainly in the private sector, billing citizens or their private insurance companies directly.
Despite decades of reforms, studies continue to show that the private sector [2] costs more, does not relieve the pressure on the public network, but sucks up its workforce while reducing the quality of care and access.
In addition to private funding, private provision is standardized within our public system: think of GMFs, long-term accommodation, pharmacies and entrepreneurial doctors who have reached stratospheric levels of remuneration.
Finally, the private sector has imported centralized management methods [3] that are disconnected from the field. Rather than prioritizing patient care and population health, we are forced to respond to so-called "performance" indicators and other short-sighted "profitability" measures (e.g., the pernicious "activity-based" funding model, ironically called "patient-centered").
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