Within Canada’s publicly financed health care system, some physicians and other advocates are promoting delivery models that incorporate increasing pro-market elements including privatization, investor-ownership, commodification, commercialization, and profit beyond the provincially-approved fee schedules. Variants of these models already exist in Canada, and more are developing.
Provincial and territorial health policymakers are challenged to ensure that service capacity is sustainable, and that it meets the health care needs of Canadians. Policymakers are grappling with the questions of whether it matters who delivers health care, and whether private for-profit delivery should be allowed, even encouraged, within the public system. A framework for approaching these questions in a way that is transparent, thoughtful, and evidence-based is long overdue. Canadian Doctors for Medicare developed the following resources to support this process.
The Health Care Delivery Assessment Tool (HDAT) provides a systematic, criteria-based approach to assessing any proposed innovation within the publicly financed system. The tool assesses proposed innovations based on four sets of criteria with the following focuses:
- Equitable access
- High-quality care
- Effective, clinically indicated services
- Effective integration and system stewardship
At their 2014 General Council, the Canadian Medical Association passed a motion brought forward by CDM to develop and use of an HDAT-like system for health care innovation evaluation. The CMA recognized that in order to assess the impact of models of delivery that are increasingly prevalent in health care transformation, such as stand-alone clinics, community-based care and home care, the Canadian Medical Association requires policy tools capable of assessing and identifying barriers to quality, efficiency and equity in emerging models of health care delivery.
The second resource developed by CDM to assist policy makers with evaluating health care proposals and initiatives is the policy tool kit. This collection of tools will assist Canadian policymakers, the public, and the media in analyzing whether proposed models of market-driven healthcare delivery should be encouraged, regulated, or opposed. We begin with the premise that healthcare should be equitably accessed by all Canadians, regardless of ability to pay, and provide a framework for examining the ways in which private for-profit delivery of publicly financed services might affect that principle.