Focus groups confirm that MDs, public differ on role of private health care

Patrick Sullivan

Canadian Medical Association Journal 1996; 154: 1247-1249

Patrick Sullivan is CMAJ's news and features editor.

In Brief

Polls conducted by the CMA in 1995 indicated that most physicians favour more private funding for Canadian health care. However, new information gathered in a series of CMA-sponsored focus groups confirms earlier findings that the public does not yet share these views. In March, a polling expert told the Board of Directors that physicians must be cautious in advocating a position on the issue.

En bref

Selon des sondages effectués par l'AMC en 1995, les médecins seraient en faveur d'une augmentation du financement privé des soins de santé au Canada. Des renseignements recueillis récemment auprès de groupes de réflexion parrainés par l'AMC sont toutefois venus confirmer que la population ne partage pas ce sentiment. En mars, un spécialiste des sondages a prévenu le Conseil d'administration que les médecins doivent faire preuve de prudence dans leurs prises de position sur cette question.

General Council must have been prescient last August when it decided to launch a debate on the issues surrounding private health care in Canada instead of coming out strongly in favour of it.

At its March meeting, the Board of Directors learned that market research the CMA has conducted since last year's annual meeting indicates that Canadians don't accept the concept of private insurance and private care, and the association and medical profession might have found themselves marginalized had they pursued the pro-privatization course.

Using data from a series of country-wide focus groups conducted for the CMA in February, Dr. Darrel Bricker said Canadians remain opposed to the concept of private funding of health care, and remain committed to the concept of equality of care. "The question is, does the medical profession want to be first over the parapet on this issue, with all the guns blazing at it?" said Bricker, a vice-president with the Angus Reid Group. "There will be a lot of bullets out there."

His comments were based on results of 10 focus groups involving Canadians from all walks of life that were held in Vancouver, Edmonton, Toronto, Montreal and Halifax from Feb. 5 to 9. In a report drafted for the board, Bricker noted that "health care may be the last area of government programming for which support for universality remains exceptionally strong. The consensus in the focus groups was that involving private money in the system would lead to two-tiered health care and that this was fundamentally unacceptable (and even scary)."

He said the public's main concerns are that ability to pay will become a more important consideration than need when determining who gets access to care, and that the facilities and physicians available to Canadians with private insurance will be of higher quality than those available in the public system.

Bricker said all focus groups stressed that Canada's medicare system is a "defining element of their personal identity as Canadians." Conversely, they said that attempts to introduce private funding here would make Canada "just like the US."

Where does this leave the medical profession? Bricker said the CMA will have to be very cautious when it raises the issue of private health care. When the issue was brought to the focus groups, he said, there was a "visceral response."

The focus-group results confirm CMA-sponsored polling conducted in 1995 that indicated Canadians and their physicians are far apart on the future of the health care system. In the spring 1995 polls, 78% of physicians said increased private-sector participation in health care was either very or somewhat acceptable, while 61% of nonphysician respondents said that forcing patients to pay for care is either strongly or somewhat unacceptable.

Bricker's report said that strongly stated physician support for additional private funding could hurt the medical profession's public image. "Many [focus-group participants] assumed that such support was motivated by doctors' concerns about their own incomes."

Bricker stressed that Canadians know little about the way medicare is funded, and they don't care: "They just want it taken care of."

The board will discuss its response to the results at future meetings. Dr. Jack Armstrong, the president, noted that medicare's future is likely to be a major issue in the next federal election, expected in the fall of 1997. He said the CMA may have to consider a longer-term focus in its approach to the issue of private funding for health care.

Dr. Judith Kazimirski, the president-elect, said the CMA's role appears to be to foster debate, as General Council directed. "We need to believe that the public does know what it wants."

"I guess the question is how far out front should we be in this debate?" added Dr. Léo-Paul Landry, the secretary general.

Bricker stressed that focus-group participants wanted physicians to work more cooperatively with other health care groups. One sign of this came when the board accepted for information a joint background paper on HIV/AIDS prepared by the CMA and the Canadian Nurses Association. The 32-page paper is "a joint project to address the challenges and opportunities presented by collaborative practice, particularly as it relates to caring for people living with HIV/AIDS." It will be presented to Health Canada this spring.

In other areas, the board:

Endorsed a template for a curriculum on gay and lesbian issues that was developed by the teaching section of the College of Family Physicians of Canada. It is designed to prepare family physicians to deal with the special needs of gay and lesbian patients. Dr. May Cohen, chair of the Gender Issues Committee, said such efforts should be encouraged because "there is ample evidence that these patients do not feel they receive adequate health care."
Directed that the CMA draft a statement of principles concerning the appointment and reappointment of medical staff. Dr. Ron Wensel, chair of the Committee on Quality of Care that will draft the statement, said the issue has attracted large numbers of physicians to meetings in Alberta, where concern is growing about morale within the medical profession. "We're very concerned about the migration of our skill set," he said. "In Alberta, we just lost most of our newly graduated family physicians, and most have gone to the US."
Approved a motion that the CMA "become an active participant in the national unity debate." Dr. Drew Young of British Columbia said that because medicine is a healing profession, it might be able to work to heal rifts in national unity. Dr. Rob Kimball of Nova Scotia said CMA activities could be included under the heading of patient advocacy. "How many of our patients will be better off in a balkanized Canada?" he asked. The board will form a working group to develop an action plan for General Council in time for the 1996 annual meeting.

| CMAJ April 15, 1996 (vol 154, no 8) / JAMC le 15 avril 1996 (vol 154, no 8) |