Public and private health-care systems: what the literature says

Since policy-makers and health-care administrators across Canada are currently interested in using privatization as a method of health-system reform, an analysis of public-private health systems and privatization initiatives is relevant, if not critical, at this time. The widespread and long-standing popularity and considerable successes of the Canadian health-care system demand such an analysis. The many investigations and other evaluative reports describing the performance of health systems and privatization make this analysis possible. The author conducted an extensive review of research and other literature on health-sector privatization and private- or public-health systems. Three themes depicting various public-private relationships were found: 1) public or private delivery payment, and administration of health care; 2) integration or separation of public- and private-health sectors; and 3) the conceptualization of health care as a commodity or a right. These themes are examined through the prism of the Canadian health-care system and recent developments in Alberta. A discussion of their operational successes, failures, limitations and other issues follows. The literature review shows that privatization, particularly if undertaken in what has been an essentially "public" health system such as Canada's, needs to be approached-if at all-with caution. Increased controls such as new forms of legislation and regulation would clearly be necessary. Research to monitor the effect of privatization initiatives would also be needed.