Kirby-Keon competition proposals draw supporters and critics.

OTTAWA -- Senators Michael Kirby and Dr. Wilbert Keon competition among sellers of health care services has met with strong and mixed responses among health care advocates. The argument is found in a paper, Why Competition is Essential in the Delivery of Publicly Funded Health Care Services. The Institute proposal was published by the Institute of Public Policy Research in Montreal.

The Ontario Medical Association offered an enthusiastic support to the Kirby-Keon statement. "Today's report by Senators Kirby and Keon is both timely and vital as hospitals in Ontario wrestle with a $600 million funding shortfall". The IRPP report echoes a similar study published by OHA in April, Advancing Accountability Through Hospital Funding Reform", funding such as teaching and location.

The Canadian Health Care Coalition expressed strong criticism, stating that the Kirby-Keon report wants patients to be seen through the eyes of an American-style health management organization--as "a source of revenue."

They add that "Peer-reviewed evidence clearly shows that market-driven health care: a) has higher death rates; b) costs more; c) provides lower quality; d) engages in schemes to cheat taxpayers; e) compromises access to public services; and f) lacks public accountability as contracts are confidential."

The Kirby-Keon report calls for a change to annual hospital budgeting. They envision this as leading to a service-based funding system and to the establishment of specialized standalone facilities that could offer lower prices for certain commonly performed procedures (cataract surgery, orthopaedic surgeries, diagnostic tests, et al). The facilities would have lower costs, because of lower overheads and more flexible job descriptions. Greater specialization, they argue would lead to improvements in service quality. Competition would encourage hospitals to contract out nonmedical services in order to improve productivity and reduce costs.

They see their proposals as a way of getting around the influence of the health care professional associations and labour unions which prevent productive use of personnel. "Significant productivity improvements could be achieved by better utilizing providers. Health care professionals should be able to use the full range of their skills and knowledge rather than being limited by rigid scope-of-practice rules."

Canadian Union of Public Employees and the Service Employees Union that represent over 150,000 health care workers have attacked the private, for-profit health care approach as more expensive, of poorer quality and that does nothing to reduce waiting lists in the public system.

CUPE has documented over 90 major privatization initiatives since January 2003. "It is an indisputable fact that privatization costs more and delivers less."