Urologists’ beliefs about privatization

In this issue of CUAJ, Mayson and colleagues¹ of the CUA Socioeconomic Committee report the results of a survey of Canadian urologists on the privatization of health care. Although one cannot make general conclusions regarding the collective opinion of Canadian urologists based on a 9-question survey with a 20% response rate, some interesting results were nonetheless observed. Of interest, more than half of the survey respondents were already receiving direct payment from patients for services; this indicates that many urologists already have a private component, albeit small, to their practice. It would be of interest to look at the proportion of private care a few years from now, since in several parts of the country the door has been opened to some private activities. More results show that 65% of respondents believe that Canadians should have the freedom to choose private health care; in contrast, almost 20% feel that private health care should not be allowed at all. What is of further interest is that most respondents (74%) believe that the presence of a parallel private system would not adversely affect the health of patients treated in the public system; at the same time 58% believe that the health of patients in the private system would improve. Essentially, many of the respondents felt that allowing privatization would improve the health of those who can afford it and not improve the health of patients in the public system. This view is somewhat contrary to the views of those who promote privatization and who argue that the public system would be relieved of some expenses, and that privitization would thus improve access and care in the public system.

As stated in the article, the eventual objective of the CUA Socioeconomic Committee is to develop a policy regarding privatization similar to other Canadian and provincial medical associations. It is unfortunate that this first attempt to gather opinions was inadequate, as only a fraction of members completed the survey. Notwithstanding this first attempt, more effort should be made to collect the opinions of urologists, to have a better understanding of our position as a whole. However, to understand this collective opinion, a constructive debate before canvassing their opinions would be helpful. Also, some advocates of privatization have proposed that certain procedures should not be universally covered in order to relieve the public system. It would be interesting to survey Canadian urologists to see what procedures they would advocate being removed from the public system. Finally, it is quite interesting to observe the debate occurring in the United States about their moving toward a Canadian-type model while we simultaneously debate moving in the opposite direction. Like most things in life, a moderate central position is often the right one.