Beyond the Chaoulli ruling

By Damien Contandriopoulos

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 financing in Canada is no small business. With a staggering $200 billion spent on healthcare services annually — that’s more than one dollar spent on healthcare for every $10 of the total economic activity in Canada — debates about healthcare services financing ought to be taken seriously.

We certainly have no shortage of pundits, from the left and the right, weighing in on the state of the Canadian health care system.  Too bad the debates aren’t often based on the facts.

In a recent study for Healthcare Policy, my colleagues and I analysed four and a half years worth of mainstream media coverage and political commentary on the landmark Chaoulli v. Quebec ruling.  This 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 for some health services.  The ruling, which is only binding in Quebec, ignited an immediate and fierce public debate on private vs. public health financing that continues across the country today.

After pouring over transcripts of all discussions in Quebec’s National Assembly, including relevant parliamentary committees, and a broad sample of mass media in print, radio and television, we found that in more than half of all the statements made in policy debates on healthcare services financing, speakers defend a given policy avenue without justifying their position with any evidence whatsoever.

In the remaining statements, individuals justified their preferences based on comparisons with information from 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 factual health related information in support of their position.

We also found that both sides of the polemic were guilty of placing ideology above evidence — but not equally.

Those espousing public funding of health services accounted for three quarters of the fact-based statements, while the statements of those in favour of privatization tended to focus more on legal justifications (‘let’s respect the law’).

Another interesting difference: those in favour of publicly funded health care tended to reinforce the negative outcomes of the ruling (‘we should keep public financing or else…’) whereas the privatization proponents emphasized positive future outcomes.  And it is noteworthy that, often, the advertised positive effects put forward in pro-private statements were at odds with available scientific evidence.

So who is winning the debate?  On that one, the jury is still out.  One thing is certain: the political furor in Canada over healthcare financing is unlikely to vanish any time soon.  One need only look at the Chaoulli-style case currently facing the BC court, and, possibly, the Supreme Court of Canada again, to see the debate is far from over.

Our examination of the politics of health care financing makes clear that too few commentators and politicos — on both sides — employ evidence to buttress their positions.  Precious little hard facts, numerous statements of dubious validity and, overall, policy preferences 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 financing is everyone’s business and it is definitely 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 forward by groups defending their own interest. This is a topic where strong evidence built from the analysis of decades of international experience is readily available.

Now it’s 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 Montréal.

See the poster based on this commentary

September 2012

This Commentary is from Commentaries, Private For-Profit Solutions to Funding & Delivery.

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