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The current health care staffing crisis has reignited the debate over the privatization of Canada’s system — and while more needs to be done to ease the pressure on hospitals, critics say more private care is not a “simple solution.”
This week Ontario Health Minister Sylvia Jones revealed a plan to help stabilize the province’s health system, which includes increasing the number of publicly funded surgeries performed in existing private clinics, though she declined to provide details on which specific facilities would be involved or which surgeries would be covered.
“Health care will continue to be provided to the people of Ontario through the use of your OHIP card,” she said at a press conference Thursday, declining to answer a question about whether she would consider allowing more private clinics in the province.
Depending on who you ask, increased privatization is either a growing threat or a possible solution to the staffing crisis being felt across the country.
Asked about the role of private clinics recently, Ontario Health Minister Sylvia Jones said the public should not be afraid of “innovation” in the health care system. (Evan Mitsui/CBC)
Yet for-profit clinics for surgery and other medical practices have existed in varying degrees across Canada for decades, and commercial agencies have quietly filled staffing shortages during the pandemic — at increasing cost to hospitals and taxpayers.
Supporters argue that some of the privatization will reduce pressure on the public system and improve triage care, while those against worry that it will drain resources and increase inequality among Canadians.
“We’re in a really challenging situation right now because the health care system is not functioning well right now — and I think that’s becoming more apparent every day,” said Dr. Catherine Smart, president of the Canadian Medical Association ( CMA ).
“Privatization is always one of the things that people bring up in this conversation,” she said. “But I think what we really need to consider is how would this actually improve service delivery for Canadians, to suddenly have a private for-profit model?”
Private clinics aim to fill gaps in care
Canada faces a acute shortage of family doctorswith millions of Canadians without access to primary care due to retiring doctors and fewer medical school graduates choosing the specialty due to lack of resources and high overheads.
The pandemic has also exacerbated the lack of access to emergency care and increased wait times for surgery, with nearly 600,000 fewer surgeries performed between March 2020 and December 2021 compared to 2019, according to Canadian Institute for Health Information (CIHI).
Almost half of adults in Canada’s 10 provinces had difficulty accessing health care in 2020 and 2021, while nearly 15 percent said they didn’t get the care they needed at all, according to a survey from 2021 to Statistics Canada.
WATCH | What’s Behind Canada’s Family Physician Shortage?
What’s Behind Canada’s Family Physician Shortage?
Family physicians Dr. Camilla Premji and Dr. Rita McCracken discuss the shortage of family physicians in Canada and what can be done to alleviate the situation.
Private clinics have stepped in to try to fill this gap in some provinces, including Quebec and Nova Scotia. Others oppose the idea of offering more private health care.
In British Columbia, the province’s highest court recently upheld a lower court’s decision dismissal of a Vancouver surgeonchallenging the Medicare Protection Act, which held that co-pay and private insurance bans did not violate Charter rights.
As it stands, Canada’s health care spending is split between the public and private sectors roughly 75-25 and at a cost of about $6,666 per Canadian. according to CIHI. Private health care services are paid for by patients mostly out of pocket as well as through private insurance.
The country is projected to spend more than $300 billion on healthcare in 2021, representing nearly 13 percent of GDP. That puts Canada roughly on par with other rich countries. (The United States spends the most on health care of any country in the OECD.)
Dr. Adam Hoffman owns Algomed, which has private clinics in Quebec and Nova Scotia, where he charges clients a subscription fee of $22 per month out of pocket, plus $20 per visit. Hoffman said that while he was once a staunch advocate of a publicly funded health care system, he now believes that private clinics are part of the solution.
“A large number of patients who end up in the emergency department are there for conditions that can be treated or prevented in an outpatient primary care clinic,” he said. TGS The house. “And these patients almost everywhere don’t have access to primary care.”
These types of private options need to be explored more broadly as Canada seeks to solve its health care challenges, said Janice McKinnon, a professor of public policy at the University of Saskatchewan and a former provincial finance minister.
“We need to do everything we can to make the system more efficient, more cost-effective and more accessible to people,” she told The House, adding that other countries, particularly in Europe, have developed models where both public and private systems can coexist.
“No government is saying: We don’t want to fix the public system, we want to create a separate one. They say we need to fix the public system and we see private options as a way to do that.”
Staff tending to a patient at Toronto General Hospital earlier this month. In the two-tier model, critics of privatization say the more complex cases are left to the public system. (Carlos Osorio/CBC)
Privatization is not a simple solution
Colleen Flood, research chair of health law and policy and professor at the University of Ottawa, has looked at health care systems around the world and says private care tends to make access more difficult for low-income residents.
Flood described privatization as a “zombie solution” that we “pull all the time instead of focusing on how to fix the public health system.”
“It’s not a simple decision,” she said. “Countries that have public-private systems spend a lot of time trying to figure out how to regulate the private [sector] so that it does not absorb all the resources of the public health system.”
In general, she explained, private clinics tend to focus on less complex procedures — such as knee and hip surgeries — but still rely on the public system for emergency services and complex treatment for conditions such as cancer and heart disease.
“So you’re diverting manpower … not only to the relatively small percentage of the population who can pay for it or have private insurance,” she said, “but you’re also diverting them away from really important care.”
Colleen Flood, professor and research chair at the University of Ottawa, says countries with public-private systems “spend a lot of time trying to figure out how to regulate private [sector] so that it does not absorb all the resources of the public health system. (Submitted by Colleen M. Flood)
Ontario’s plan to fund private clinics with public funds could potentially be a more efficient way to provide services, depending on the costs ultimately borne by taxpayers, said Maude Laberge, a professor of health economics at Université Laval in Quebec City. .
“This is an aspect of the negotiations between the government and these clinics,” she said. “As long as the patient doesn’t have to pay… If a clinic can do something really well – like it’s done in the hospital or in the community – then there’s no problem with having such private, specialist clinics.” the patient has to pay, then it leads to fairness issues.”
Staffing by private temp agencies doesn’t seem to have solved the crisis in Ontario, where some hospitals have paid millions more to such firms to help staff intensive care units and emergency rooms, at an hourly rate of more than twice that of unionized nurses, since first reported by Toronto Star this week.
“Where is the stewardship of our tax dollars?” said Dr. Michael Warner, medical director of intensive care at Michael Garron Hospital in Toronto. “And then what isn’t that money being spent on because it’s being spent on nurses?”
WATCH | Critics sound alarm over Ontario’s reliance on private nursing agencies:
Critics have raised concerns about Ontario’s reliance on private nursing agencies
With a nursing shortage in Ontario, hospitals are increasingly relying on nurses from temporary staffing agencies to help fill the gap. Critics worry that public dollars are going to these private agencies instead of better salaries for nurses.
The University of Toronto Health Network (UHN) spent just over $1 million to hire nurses from various agencies in 2018 – but that increased to over $6.7 million in 2022 alone, up from $4 million from which were related to the hiring of private nurses to work in intensive care units.
“What we’ve seen during COVID is that these agencies are charging a lot more, and I’m not sure where their money is coming from, but hospitals are paying much higher hourly rates,” Warner said. “What they did during the pandemic was predatory and exploitative.
Transforming the public system?
Those who support privatization say Canada’s health care system desperately needs openness to new ideas, with Jones, Ontario’s health minister, saying last week that Ontarians should not be afraid of “innovation.”
But critics say there is little evidence to suggest the situation is improving with the private services we already have – even though they cost significantly more – or that more of them will help.
“While there may be ways to improve the…
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