[the beginning of an active debate...dr]
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Michael Rachlis said of health care
"The main issues concern management rather than money."

This has been an often repeated theme, and many Canadians regardless of
ideological beliefs  agree with Michael's remarks.

Wouldn't Canadians be better off if government's strengthened their role
as regulator? And, is a strenghtened regulatory role less likely as
long as  governments remain in a conflict of interest?

In Nova Scotia the role of the Districts and Department of Health is to
"To govern, plan, manage, monitor, evaluate and deliver health
services".

 Regulation is a normally a government responsiblity but its not
included in the list (unless regarded as part of governance????).

We know that many people have innapropriate waiting times and that  the
consequences include increased  discomfort, disability, and even death

Within the Capital District in Nova Scotia there are excessive times
for many services, including waits for people with serious (category 3)
emergencies.  Our ambulances bring people to hospital's quickly but once
there patients frequently have  unacceptable waits for care.  The
amublance service has a contract, with performance requirments and
penalties for failure.  The District and Hospitals are not subject to
such performance requirements, nor are there penalties for failure.

Is there clear evidence that contracting out services, with clear
performance requirements leads to poorer results? Should governments
enforce performance requirements for the parts of the Canada Health Act
important to patients including accessability?  And didn't Romanow muse
that governments also have a resonsibility to insist on quality?  Will
govenment insist on quality and access as long as they are regulating
themselves?

Why not explore Rachliss' notion  that management problems are the root
cause of our problems  by reviewing ways to  strengthen government's
role as a regulator and as universal insuror.  This might mean private
or public sector delivery of universally insured services but with clear
performance requirements and perhaps even P3 hospitals.

Best wishes

David Zitner

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