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To the Editor: Dr Devereaux and colleagues¹ acknowledged the ongoing debate in Canada about the optimal mix of private and public funding of health care expenses. However, we disagree with their characterization of this debate as between private for-profit and private not-for-profit entities. In fact, the majority of hospital-based care in Canada, including nearly all dialysis, occurs in public not-for-profit institutions. While nominally independent, Canadian hospitals generally receive almost all their funding from provincial governments and are administered by boards that must answer to them.² In our opinion these hospitals function as public institutions.

The comparison of private not-for-profit and private for-profit dialysis clinics is thus of limited relevance to countries such as Canada, where dialysis is mainly provided by public hospitals. While we do not advocate a shift to US-style private for-profit dialysis, we think it is unfortunate that the conclusions of Devereaux et al do not reflect the . . . [Full Text of this Article]

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