Bégin Monique
Department of Health Administration, University of Ottawa.
Healthc Pap. 2004;4(4):35-40; discussion 80-4. doi: 10.12927/hcpap.2004.16851.
Most Canadians think that "medicare"/our healthcare system (for the differentiation is certainly not clear) is "public," meaning universal and pre-paid by their taxes. Those who have heard of the five conditions of the Canada Health Act (CHA), or at least the phrase, "public administration," are doubly confirmed in their belief. It comes as a surprise to concerned citizens to learn that, to get federal funding, a province has to set up a "single payer" for health services to fall under medicare, that is, hospitals and physicians. Then, if more information is introduced to distinguish between funding and delivery of services, and it is stated how the former is public, while the latter is mainly private, the audience starts challenging the speaker. Explaining that the delivery of services is private because doctors or nurses are not civil servants, for example, comes across as one more great Canadian fiction. "After all, they are fully remunerated by public funds--my taxes." All of this to recognize that, in Canada, discussions around the public/private divide, from whatever angle, are surrounded by preconceived, often common-sense, ideas rejected mainly by students of healthcare systems.
大多数加拿大人认为“医疗保险”/我们的医疗体系(因为二者的区别并不明确)是“公立的”,意思是全民覆盖且由他们缴纳的税款预先支付费用。那些听说过《加拿大健康法案》(CHA)的五项条件,或者至少听说过“公共管理”这个说法的人,更加坚信这一点。当忧心忡忡的公民得知,为了获得联邦资金,一个省必须为属于医疗保险范畴的医疗服务(即医院和医生服务)设立一个“单一支付方”时,他们会感到惊讶。接着,如果引入更多信息来区分服务的资金来源和提供方式,并说明前者是公共的,而后者主要是私人的,听众就会开始质疑演讲者。例如,解释说服务的提供是私人性质的,因为医生或护士不是公务员,这听起来就像是又一个加拿大式的荒诞说法。“毕竟,他们完全由公共资金——我的税款——支付薪酬。”所有这些都表明,在加拿大,无论从哪个角度围绕公私划分展开的讨论,都被一些先入为主的、通常是常识性的观念所包围,而这些观念主要遭到医疗体系研究者的否定。