The public/private debate in the funding, administration and delivery of healthcare in Canada

Abstract

To help clarify the confusing debate concerning the public-private divide in Canada and the respective positions of the Romanow and Kirby reports, a new approach is proposed. The funding, administration and delivery of the healthcare "system" is split into distinct analytical categories and then applied to three major coverage groupings: universal public (Canada Health Act) coverage for medically necessary/required services; mixed coverage for drug care, home and long-term care; and private health goods and services. While there were no fundamental differences between Romanow and Kirby concerning the funding of public healthcare in Canada, there were some important differences on issues of administration. In particular, the Romanow report recommended that home mental healthcare services become universally covered under the Canada Health Act as well as fundamental changes to the regulation and administration of prescription drug care. The reports also differed in terms of framing the private delivery question, with the Romanow report questioning whether the evidence justified private-for-profit delivery replacing current private not-for-profit or public arm's length delivery modes.