Privatization of health care | What if it wasn’t such a fantastic avenue?

On March 5, I read a scientific article recently published in The Lancet, an academic journal often referred to in the field of health. According to the study described there1, private healthcare, at best, does not seem to bring any significant benefit to the quality of care received by the population. And at worst, it has deleterious effects on the various indicators that have been evaluated.

The authors, based in the United Kingdom, searched the international scientific literature to measure the effects of the privatization of health services on the quality of care received by the population. There are studies on different European countries, as well as the United States and Canada. Although they noted that few studies still exist to date on the subject, the picture they have already managed to draw remains no less striking for the reader. And these are findings that deserve to be more widely shared, as the implications seem important.

What are the indicators that are considered here, more precisely? During their approach, the authors took into account the state of health of the people (e.g.: the evolution of the number of avoidable deaths, the rate of infection in healthcare environments), the conditions of employment and work of staff, accessibility of services, and finally, the financial performance of health establishments.

On all these dimensions, the use of services provided by the private sector has tended to have negative repercussions, compared to establishments remaining under the control of the local public network.

While this research approach is not without limitations, it is part of an essential process of evaluating the impact of the privatization of the health system. Scientific interest in these questions must be encouraged, as this serves to guide societal choices that are anything but trivial. By gravitating into the academic sphere, I have privileged access to this scientific data. However, the latter should be more accessible and popularized, all aimed at political decision-makers, but also at the general public, to accurately inform decisions that concern the community.

The content of the information mentioned here also calls into question more broadly the credibility of speeches praising privatization as a solution to the shortcomings of the public network, if they are not based on scientific data including relevant indicators.

When we shape the organization of services, we cannot avoid paying attention to the repercussions of these strategic choices on the quality of care received by the population.

These data finally come, and this is significant, to support the testimonies of people, close to the “floor”, who are publicly concerned, and have been doing so for years, about the growing share that is given to private health in the Quebec2,3,4,5,6. For example, they share their fear that this will lead to the creation of a system that leaves the most vulnerable people even further behind. And relying wholeheartedly on the private sector as a miraculous savior of the health system also means taking the risk of aggravating the weaknesses of the public network.7.

To conclude, I have a real attachment to the idea of ​​a public service, a real collective good, which must be given the means to fulfill its mission to the population. This is what partly motivated my decision to write these lines, as a researcher and citizen. Continuing to see health as a heavy and costly expense in the short term, a burden that can easily be given to the private sector, is a major error that will end up costing us all, at the end of the day, even more. .

1. To read the study (in English)

2. Lia Lévesque’s article, “We need more people, say unions” (January 24, 2024)

3. The opinion letter from Lucie Lamarche and Nicole Filion, “The need to re-establish the terms of the debate” (June 12, 2023)

4. The article by Ugo Giguère, “Doctors in favor of the public system excluded from consultations” (May 5, 2023)

5. Jacques Ricard’s opinion letter, “Undress Pierre to dress Paul” (January 21, 2023)

6. Réjean Hébert’s opinion letter, “Still the mirage of private health” (September 7, 2022)

7. Isabelle Hachey’s article, “The public, the private and the $500,000 volunteer” (March 3, 2024)


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