Romanow and Kirby on the public/private divide in healthcare: demystifying the debate

In this paper, we review recent developments in the debate over the role of the private sector in healthcare in Canada, with a particular focus on the two major federal reports that were released in the autumn of 2002, the final report of the Senate Committee on Social Affairs (the Kirby report ) and the Romanow Commission report. It is possible to see these reports as representing two polarized positions in the public versus private debate. Kirby has often been portrayed as an advocate of privatization whereas Romanow has been given the role of champion of the public system. However, both conceptualizations are simplistic and inaccurate. We argue that rather than cast these two reports as proxies in an ideological dispute, it is more helpful to try to glean from them workable and flexible solutions to this immensely complex and divisive debate. More specifically, using the similarities and the differences manifest in these reports as a key reference point, we clarify the extent to which the terms used in the public policy debate have accurately represented the reality of the funding and delivery mechanisms that actually characterize the Canadian healthcare system. This allows us to draw some provisional conclusions on the degree of consensus that prevails in the healthcare debate, and on the sources of pressure for change. Given the universal emphasis currently placed on the need to base policy conclusions on "evidence," we also look at some recent academic contributions to the debate, notably by Raisa Deber and Devereaux et al., in order to better understand what the best available evidence indicates about the merit of the various forms of healthcare delivery. As well, we examine examples of private delivery of health services, including the Morgentaler clinics, that point to the importance of retaining the space for experimentation with forms of delivery that currently exists within the Canadian healthcare system.