Canada's doctors ask for public input, but that can't be an end in itself

Why do physicians need average folks' help?

I have to admit to being a bit skeptical at the outset about the Canadian Medical Association’s announcement yesterday that it’s launching an elaborate consultation with the general public about the future of health care. My first thought was that it’s properly the government’s job to try to engage citizens in a debate; what we need from the doctors’ lobby are clear proposals on the hard issues and then vigorous arguments in favour of them.

With that in mind, I asked Dr. Jeff Turnbull, the CMA’s president, if physicians don’t know enough already to present a set of precise recommendations. And don’t the docs cumulatively understand the system far better than the average folks they’re proposing to consult with anyway? Turnbull framed the CMA’s outreach plan as a way of building a coalition, or, as he put it, a consortium. “Once we get a consortium of individuals,” he said, “other allied health professionals, doctors, patients, community members, then we’ll actually have clout, then we’ll have our decision-makers listening.”

It’s not a bad strategy for amplifying the influence of the already powerful doctors’ organization. Hence, the CMA’s new website, where it hopes to attract many comments from Canadians, and its plan to hold town-hall meetings across the country in 2011. As well, Turnbull said the CMA will eventually appoint “a blue ribbon panel to look at resourcing options”—I take it he means how we’re going to pay for care going forward—and deliver a “final action plan” next fall.

The timing is crucial here, since the agreement under which Ottawa funds about 20 per cent of the provinces’ health care costs runs out in 2014. So Canada has about three years to work things out. The CMA’s general inclinations are already clear: not only should universal health insurance be preserved, coverage should probably be extended to cover prescription drugs and long-term care.

The CMA sees the need for big change within the existing framework. The key paragraphs in the background document the group released last summer, Health Care Transformation in Canada, are the ones that sketch ideas for injecting efficiency into what would still be universal, publicly insured care:

“The system should be guided by properly structured incentives to reward efficient provision of timely, high-quality patient care. This would include incentives such as activity-based funding of hospitals (i.e., paying on the basis of services provided), and pay-for-performance measures for health care providers, with competition based on valid measures of quality and efficiency. The system would utilize both public and private service providers, and put uniform requirements and regulations in place for measuring quality.”

Importing such market-like efficiencies into the system without sacrificing its egalitarian merits would be a landmark policy achievement. It won’t happen, though, simply because the CMA reached out to Canadians. The fact is that most of us don’t ever see the system as a whole—we glimpse the organized chaos of an emergency room, sit in a doctor’s reception area praying we aren’t breathing in worse germs than we came with, wonder when the specialist’s office is going to call back, if ever.

So let’s hope the CMA conceives of its consultation process very much as a means to a political end—a way to bolster its case, the better to sway governments. The physicians should keep in mind that when it comes to really hard public policy issues, consultation processes too often devolve into exercises in putting off the difficult job of moving beyond generalities to workable, concrete proposals for reform.

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