In March of 2017, one of Canada’s most distinguished academics, Professor Gordon Guyatt at McMaster University, talked about healthcare. In particular, his area of expertise in public and private healthcare, with an emphasis on the advantages and disadvantages of each system.
He took the time to have a discussion with me on the nature of the two different healthcare systems, the positives and negatives of each, and which might interest particular populations within a country.
When it comes to the general factors for the discussion for private versus public healthcare, Guyatt said, “When I gave the talk, I ask people, ‘How should we decide?’ There are a number of things that people raise. One is health outcomes.”
“It depends on the ultimate goal of healthcare, such as keeping people healthier. We also must consider what the impact is on people’s health, access to care, patient satisfaction, and autonomy—often characterized as a choice, and so on.”
He went on to describe the cost of healthcare as a major factor. But he also lamented that there is a lot of misinformation. This is distressing because the necessary ingredients for an informed decision by the public on the matters of healthcare require accurate information, not misrepresentation and distortion.
He notes that one of the major drivers for everything is the dissatisfaction with the way things are working now. That there must be a better way.
“You are looking for something different. It depends on who you are talking to. Their perspective might make a difference,” Guyatt explained. “The outcomes of private versus public funding will differ depending on who you are.”
“If you are very rich, it is a different calculus than if you are very poor. It changes across that spectrum. And it is very different if you are a healthcare provider versus a healthcare consumer.”
Income becomes an important factor. If you are a wealthy citizen, then the healthcare considerations will be different than if you are not as wealthy or a regular Canadian citizen. One concern for people is the sustainability of the current healthcare costs.
These differing frames of reference change the ways in which people are able to take into account the idea of “cost” within healthcare. He continued, “When I talk to audiences, there are notions that people have about what is affordable. There are notions people have about what it will do to their own income.”
To deal with the sustainability of the healthcare system, Guyatt said that he asks people about the healthcare expenditures as a proportion of the GDP over the last seven years. He gives multiple choices: gone up every year, most years, and so on.
“People end up surprised when the answer is that it has been stagnant or declined. So, as a percentage of GDP, healthcare is actually lower than it was seven years ago. They also tend to be surprised when you inform them that in 1991, that it was 10% of GDP for all healthcare expenditures. Now, it is a little bit below 11%. That is over more than 25 years.”
The healthcare expenditures over 25 years have been more extreme, according to Guyatt, “About 7% to 7.5%”. These influence the perception of the public on the costs of healthcare spending as a share of national wealth, which turn out to be false perceptions.
If we don’t clear up the misinformation, then making an informed choice on healthcare systems won’t be possible, but Gordon Guyatt is doing what he can to change that.
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