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Canadian Public Health Association

A Fine Balance: fundamental question - 1

A Fine Balance:   A Public Health Perspective on Health System Reform

The fundamental question

The question on which the entire debate hinges is this: is Canada still a country that believes in health as a public good, or do we "let the devil take the hindmost?"

That is, do we still hold the principle, manifest in the creation of Medicare, of a collective social responsibility for our shared problems?

CPHA believes that the answer to that question is yes, and that the health system (including but not limited to the health care system) is a public good and not a commodity: All Canadians should have access to the benefits of our available knowledge and resources for preserving and enhancing their health, regardless of their ability to pay or where they happen to live in Canada.

If we say yes to this fundamental question, then the next question is not whether to pay for it through investment of public funds, but how to organize the system in such a way that the investment produces the best possible health outcomes for Canadians and with the greatest efficiency.

If the answer is yes, two of the four scenarios presented by the Commission for consultation would not be acceptable from a public health point of view because they would increase inequities in access and health outcomes. Even the technical arguments for either scenario are weak: research shows that user fees reduce access for the poor without achieving their ostensible aims of reducing waste and mobilizing resources to increase quality and effectiveness of services,3,4 and that for-profit health services are not only more expensive but lead to poorer health outcomes than publicly administered or not-for-profit services.

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