But the lines are blurring between private and public health care. We should ask ourselves if this blurring of margins really matters as long as patients are getting the care they need in a way that is beneficial and acceptable to them and in a way that provides for long term sustainability of public health care.

As “public” delivery and “private” delivery become more intertwined in many aspects of health care, the debate over which is better may simply become irrelevant. Whether the private funding is in the form of donations to hospital foundations for equipment and infrastructure improvement, hospital construction, medication funding or even communications technology, it is very likely that more combinations of public and private delivery will emerge to fill the requirements of an increasingly complex health care delivery system.

With Ontario’s hospitals in position to negotiate 2 year accountability agreements with their new Local Health Integration Networks the issue of sustainability is key. Of the province’s 154 public hospitals it is reported that 75 are facing a deficit for the fiscal year starting April 1 and there are no bail-outs in sight at the present time. It hardly seems reasonable that at the same time access is strained and the Ontario budget has included funding for 9,000 more nurses, hospitals may be forced to cut nursing positions to balance their budgets. How can more services be provided to more patients that need them in a sustainable way?

The concern over sustainability is receiving a great deal of attention across Canada. In British Columbia, Bill 21 has been used to amend BC’s Medicare Protection Act. It defines sustainability in an attempt to ensure that the British Columbia Medical Services Plan “is administered in a manner that is sustainable over the long term, providing for the health needs of residents of British Columbia and assuring that annual health expenditures are within taxpayer’s ability to pay without compromising the ability of the government to meet the health needs and other needs of current and future generations”.

Canada’s health care system advances into the 21st century with diverse patient requirements which are not successfully addressed in many cases. Seeking to define sustainability is a necessary step toward supporting a strong public health care system in the long term and in supporting the individual by enshrining the values of individual choice, personal responsibility, innovation, transparency and accountability.

The best kept secret in Canada may be that private funding already co-exists with public provision in many instances. With legislation like BC’s Bill 21, long term balancing of societal needs both internal and external to health care budgets is likely to be enhanced.