The growing involvement of the private sector in Canadian public health systems

This week, the Ontario provincial government announced it is expanding the number of private clinics providing medical services.

Currently, Ontario has about 900 such clinics, and they primarily offer medical imaging and cataract surgery. Sylvia Jones, the province’s health minister, said this week the government is expanding its program to include hip and knee replacements.

The province is being careful not to violate the Canada Health Act by requiring people to pay for necessary medical procedures. That would jeopardize the C$20 billion the province will receive this year from the federal government for health care. Although the clinics will be privately run, their procedures will be covered by the provincial health plan as if they were performed in public hospitals.

Ms Jones said the expansion would allow more such procedures to be carried out and that doing so would reduce waiting times for patients. Her critics argue that this will further undermine the public system, that it could actually increase wait times and that it is a step toward the complete privatization of health care.

The government’s announcement came around the same time the publication of a study by the CD Howe Institute this does not take sides in the debate but reflects the level of private healthcare already in place in Canadian provinces.

Like everything in the Canadian healthcare system, the level of privatization varies by province. But the very short version of the paper is that the bar is already much higher than most people might expect, and that some of it is entrenched.

Katherine Fierlbeck, the report’s author and a political science professor at Dalhousie University in Halifax, told me that if you add up all the major privately provided services, including medications, dentistry, physiotherapy and optometry, “it’s a lot.” of health care – about 30% – that we have no problem, for the most part, bringing it back into the private sector.”

Beyond that, private entities, both for-profit and nonprofit, have long provided medical tests, provided nurses for home care or to cover hospital staffing shortages, built new hospitals in collaboration with governments, and used expensive equipment such as MRI machines in such industries. provisions. In Quebec, 642 doctors now work outside the public system, which has 22,981 doctors.

Professor Fierlbeck, who studies Canadian health systems, said she has noticed a change in the political dynamics surrounding public health care. In the past, she said, talk of privatizing health care or making patients, or private insurers, pay for procedures covered by the provinces was politically toxic.

“In my lifetime, and especially over the last few decades, Canadians have had a really visceral fear of private healthcare, largely because of the proximity to the United States and all the horror stories that come with it,” he said. “That’s why there’s this knee-jerk reaction to private healthcare. Things sell more easily politically when they are black and white. When you say there’s a lot of gray out there, it’s harder to capture the public imagination.”

But Professor Fierlbeck said factors such as the severe shortage of family doctors in many provinces, long waiting times for some surgeries and in emergency rooms, and hospital closures due to staff shortages had created “a certain form of moral distress” among many Canadians.

These people “still support public health care in principle,” he said, but if a private clinic could serve their children before the public system does, many of them would not hesitate to choose that option.

Professor Fierlbeck said she was testing some hypotheses about private healthcare in other research. But she offered a note of caution to provinces like Ontario that are moving more treatments and procedures from hospitals to private clinics.

To date, most of these clinics are owned by groups of doctors and are relatively small businesses. But Professor Fierlbeck predicts that as the clinical business grows, large US-based healthcare companies will show a keen interest in the Canadian market.

“Now we have these small independent clinics set up by local people,” he said. “They don’t have much political clout and aren’t interested in behaving aggressively. But if you open the door and allow these big companies to come in from the United States, then they’re going to act aggressively, the way pharmaceutical companies act aggressively, and you’re going to have to kind of fend off interests that really want to expand. the parameters of private business with ongoing lobbying or legal action.”

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