On distorted outcomes

Having apparently decided that two levels of government and the health systems under their control (along with multiple propaganda tanks funded by who-knows-how-much-money contributed by we're-probably-not-even-allowed-to-ask) make for an insufficient number of mouthpieces for health-care privatization, Murray Mandryk continues to take on the role for himself. But let's see what's missing from both his latest column, and the health-care debate generally.

To start off with, I'll note that the primary care clinic touted by Mandryk today is rather less offensive than some of the other, more corporate-controlled facilities which he's so eagerly lumped together as "innovation!".

As I noted in this column, though, any effort to actually test the relative efficiency of the private and public sectors should involve some basis for a fair comparison between the two. But instead, it's hard to imagine a more distorted set of incentives than the one pushing all parties toward leaving the new clinic to private physicians.

After all, in setting up a separate clinic, the health professionals involved can count on a reliable source of patients whose treatment can be billed under the provincial health insurance plan - representing a nearly-guaranteed flow of new funding for the structure that allows for private profit. And the proximity to a publicly-funded facility to deal with tougher cases who are more trouble than they're worth from a profit standpoint is an added bonus.

But if the Regina Qu'Appelle Health Region were to set up a publicly-administered community clinic to carry out exactly the same tasks, it would receive...not a dime from the provincial government beyond its existing funding envelope. Which means that *given a lack of willingness to consider publicly-administered options*, the best the health region can hope for is to push as many patients as possible toward private clinics to reduce its own backlog.

And that's a shame, because it's entirely plausible that the health region could do better managing a clinic and integrating it into our broader health-care needs if it received an equal amount of funding to do so. But the odds of that happening are of course zero.

In other words, the reason why a private clinic carries any particular appeal is that our system makes additional direct funding available for privately-delivered medicine, but not for publicly-delivered medicine. And while I'll readily acknowledge that the overall system has been in place under governments of different stripes, the Saskatchewan Party's obsession with privatizing as much as possible and refusing to fund public facilities looks to be making matters far worse.

Once again, then, the push for a private clinic to reduce ER times suggests less that privatization is the right answer than that the Saskatchewan Party won't accept any other answer. And citizens should expect better, rather than buying the Wall spin that "innovation" means moving as much care as possible toward private delivery.

[Edit: clarified wording.]