228. Deber R B. (2002), ‘Delivering Health Care Services: Public, Not-For Profit, or Private?’ Discussion Paper No.17, Accessed at http://www.homecareontario.ca/docs/Romanow/17/Deber.pdf, on 13.03.2006

The paper is focused on the following question: "How should the Canadian system determine whether government, non-profit organizations or for-profit organizations deliver which programs and services?" What is the appropriate role for private delivery within Canada’s health care system? The paper highlights some of the lessons learnt. These are, a) Public, NFP, and FP organizations differ considerably among themselves; each contains a wide range of performance, ranging from excellent to poor. Any generalizations are likely to have exceptions. Attempts to compare performance across organizational types are further complicated because they tend to serve different market niches. FP firms are not identical to NFP organizations – they are likely to offer a different mix of services, to a different clientele, and with different cost structures. For example, the widely reported differences in costs and outcomes between FP and NFP hospitals in the US are difficult to interpret because none of the teaching hospitals in these studies were FP; b) Competition and cooperation must be balanced, competition can introduce additional barriers to such cooperation; c) Measuring and monitoring of performance is essential, particularly in contracting arrangements; d) Measuring and monitoring of performance can be costly and difficult. When desired outcomes are difficult to specify precisely, contracts may become elaborate and costly, with particularly adverse impacts on smaller providers; e) Changing delivery structures also changes power relationships , and with them, how resources are allocated; f) Health human resources issues must be dealt with; g) The assumption that we can have a competitive model with a single public payer is naive; firms require either predictable revenue streams or the possibility of revenue generation outside the publicly funded system.