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Beyond the Chaoulli ruling

Debates on our health system need to be based in evidence A version of this commentary appeared in the Huffington Post, Vancouver Province and iPolitics.ca Healthcare f inancing in Canada is no small business. With a staggering $200 billion spent on healthcare services annually thats more than one dollar spent on healthcare f or every $10 of the total economic activity in Canada debates about healthcare services f inancing ought to be taken seriously. We certainly have no shortage of pundits, f rom the lef t and the right, weighing in on the state of the Canadian health care system. Too bad the debates arent of ten based on the f acts. In a recent study f or Healthcare Policy, my colleagues and I analysed f our and a half years worth of mainstream media coverage and political commentary on the landmark Chaoulli v. Quebec ruling. T his was the decision by the Supreme Court of Canada which ruled that prohibiting private medical insurance was a violation of the Quebec Charter of Human Rights and Freedoms, particularly in light of the long wait times f or some health services. T he ruling, which is only binding in Quebec, ignited an immediate and f ierce public debate on private vs. public health f inancing that continues across the country today. Af ter pouring over transcripts of all discussions in Quebecs National Assembly, including relevant parliamentary committees, and a broad sample of mass media in print, radio and television, we f ound that in more than half of all the statements made in policy debates on healthcare services f inancing, speakers def end a given policy avenue without justif ying their position with any evidence whatsoever. In the remaining statements, individuals justif ied their pref erences based on comparisons with inf ormation f rom non-healthcare sectors such as education, based on juridical constraints or based on constraints set by current practices. In only a dismal one tenth of all the statements made about the Chaoulli decision did the speaker use evidence or some f actual health related inf ormation in support of their position. We also f ound that both sides of the polemic were guilty of placing ideology above evidence but not equally. T hose espousing public f unding of health services accounted f or three quarters of the f act-based statements, while the statements of those in f avour of privatization tended to f ocus more on legal justif ications (lets respect the law). Another interesting dif f erence: those in f avour of publicly f unded health care tended to reinf orce the negative outcomes of the ruling (we should keep public f inancing or else) whereas the privatization proponents emphasized positive f uture outcomes. And it is noteworthy that, of ten, the advertised positive ef f ects put f orward in pro-private statements were at odds with available scientif ic evidence.

So who is winning the debate? On that one, the jury is still out. One thing is certain: the political f uror in Canada over healthcare f inancing is unlikely to vanish any time soon. One need only look at the Chaoullistyle case currently f acing the BC court, and, possibly, the Supreme Court of Canada again, to see the debate is f ar f rom over. Our examination of the politics of health care f inancing makes clear that too f ew commentators and politicos on both sides employ evidence to buttress their positions. Precious little hard f acts, numerous statements of dubious validity and, overall, policy pref erences mostly explained by the group to which the speaker belong characterize public dialogue on the health system in this country. We deserve better. We deserve evidence. Healthcare f inancing is everyones business and it is def initely something that ought to be widely debated in the public sphere. But at the same time, it is too big an issue to be decided on weak and partisan rhetoric put f orward by groups def ending their own interest. T his is a topic where strong evidence built f rom the analysis of decades of international experience is readily available. Now its time to make that evidence part of the national dialogue. Damien Contandriopolous is an expert advisor with EvidenceNetwork.ca and a professor in the Faculty of Nursing at the University of Montral.