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Professor Gordon Guyatt, MD, MSc, FRCP, OC is a Distinguished University Professor in the Department of Health Research Methods, Evidence and Impact and Medicine at McMaster University. He is a Fellow of the Canadian Academy of Health Sciences.
Here we talk about the big wins from public healthcare compared to private healthcare on most metrics.
Professor Guyatt ran for the NDP four times and lost “honorably” four times. He replied, “I do not know about honorably.” At that point, I laughed because it was a good joke. However, this prefaced some conversation with Guyatt about healthcare.
For example, the New Democratic Party in Canada may more probably work with platform positions and policies leaning more in ways favorable to the general public regarding healthcare. For those on the outside of this slant, they may value choice.
These types value the freedom and autonomy in their healthcare selections. This means the private funding model of healthcare, which benefits the rich. The other, the NDP type mentioned before, represents benefits or interests more for the poor.
Although, simplistic, it represents the split between private and public healthcare well.
“Those are different perspectives. The issue is if one were talking about the values issue. The value comes down to equity versus what people call ‘autonomy’ or ‘choice,’” Guyatt explained, “On the one hand, there are people who say, ‘You should not have financial barriers to high-quality healthcare. Everyone should get the highest quality healthcare that the system has to offer.’ That is one value.”
The other value Guyatt describes is the ways in which people spend money on healthcare similar to other things in their lives, including a better house or an upgrade in a car. That is, the individual Canadian citizen should be able to spend resources in a similar way on their healthcare.
Guyatt stated, “That is a fundamental value and preference divide, which tends to follow a left-right distribution. The folks on the left value equity more. The folks on the right value choice or autonomy more.”
The discussion shifted into an elimination of autonomy as a consideration. The frame of mind or outcomes if one takes choice or freedom as a value within the set of values thought important for oneself.
“Let’s say one thinks it is a good thing to constrain healthcare expenditures and say that you do not want too much GDP going towards health, the dramatic contrast with that concern is the United States and more or less the rest of the high-income countries,” Guyatt said.
Guyatt compared various areas and countries of the world on private and public healthcare. The United States is 45% public and 55% private. Canada is about 70% public and 30% private. France and Germany are about 75% public and Scandinavia tends to be over 80% public and at or below 20% private.
The United States, in developed nations, stands out. It becomes the proverbial sore thumb or a “big outlier with a much smaller proportion public than the rest of the Western world,” Guyatt described.
“Not coincidentally, they take the cake in terms of percentage of GDP spent on healthcare in the vicinity of 18% now. So, the reasons for that is administrative costs are in Canada perhaps 16 and 17% of our healthcare expenditures,” Guyatt stated, “In the US, it is over 30%. As soon as you make people pay privately, everybody has to buy health insurance, then you have huge administrative costs.”
That means insurance companies need to be founded and maintained. They make packages. They compete with one another. A large documentation is needed for all health services. This becomes a big administrative cost with the private funding compared to the public funding.
Guyatt concluded, “Government cannot constrain healthcare costs, essentially. They cannot set boundaries effectively within a private funding model. In terms of constraining healthcare costs, public funding is an out and out winner by a long margin.”
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The British Medical Journal or BMJ had a list of 117 nominees in 2010 for the Lifetime Achievement Award. Guyatt was short-listed and came in second-place in the end. He earned the title of an Officer of the Order of Canada based on contributions from evidence-based medicine and its teaching.
He was elected a Fellow of the Royal Society of Canada in 2012 and a Member of the Canadian Medical Hall of Fame in 2015. He lectured on public vs. private healthcare funding in March of 2017, which seemed like a valuable conversation to publish in order to have this in the internet’s digital repository with one of Canada’s foremost academics.
For those with an interest in standardized metrics or academic rankings, he is the 14th most cited academic in the world in terms of H-Index at 222 and has a total citation count of more than 200,000. That is, he has the highest H-Index, likely, of any Canadian academic living or dead.
He talks here with Scott Douglas Jacobsen who founded In-Sight Publishing and In-Sight: Independent Interview-Based Journal. We conducted an extensive interview before: here, here, here, here, here, and here. We have other interviews in Canadian Atheist (here and here), Canadian Students for Sensible Drug Policy, Humanist Voices, and The Good Men Project (here, here, here, here, and here).
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