Code Blue: Does Canada need a parallel private health-care system?
With Canada’shealth-caresystem “in crisis” as described by many front-line workers, there is a renewed push towards leaning on private facilities to ease the pressure on public hospitals.
In Ontario, which is grappling with staffing shortages, temporary emergency room closures and surgical backlogs, more publicly covered surgeries will be performed at private clinics, Health Minister Sylvia Jones announced last month.
That announcement has reignited a long-standing debate over privatization of the Canadian health-care system, with other provinces weighing their options.
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While some experts consider privatization a possible solution to staffing shortages and long wait times, others see it as a threat to public care.
“Canada is the only country in the world where it is illegal to obtain private health insurance when there are long wait-lists. That surely says something,” said Dr. Brian Day, medical director of Cambie Surgery Centre in Vancouver and past president of the Canadian Medical Association (CMA).
Day, whose private clinic in Vancouver has been up and running since June 1996, has long been advocating for a parallel private system in the province.
He launched a legal challenge to the B.C. Medicare Protection Act, saying wait times in the public health system are too long and stopping patients from paying for those services outside the public system violates their rights.
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In July, the B.C. Court of Appeal dismissed the Vancouver surgeon’s challenge.
However, in their ruling, the judges accepted that the act’s provisions “deprived some patients’ right to security of the person by preventing them from accessing private care when the public system had failed to provide timely medical treatment.”
Days says the funding model needs to change in the country, adding that the “state-run monopoly” is killing Canadians.
“The promise was that we would have a universal system where everyone was treated, but people are dying on wait-lists,” he said.
Dr. Brian Day, medical director of the Cambie Surgery Centre in Vancouver.
THE CANADIAN PRESS/Darryl Dyck
Currently in Canada, the public sector pays for 75 per cent of the total health expenditures across the country, while 25 per cent comes from the private pool, according to the Canadian Institute for Health Information (CIHI).
Dr. Michael Rachlis, public health physician and adjunct professor at the University of Toronto, said privatization is not the solution as it creates inequalities, costs more and compromises quality of care.
“Privatization of anything would make no difference in the emergency room wait times next week or a year from now. It’s just zero difference. They’re completely different issues.”
Eugene Litvak, adjunct professor at the Harvard School of Public Health and president of the not-for-profit Institute for Health Care Optimization in Boston, agrees.
He said involving more private hospitals will not solve Canada’s nursing shortage problem and more money does not necessarily mean it will cut ER wait times.
“What I think the Canadian health-care system is lacking is a scientific approach of what needs to be done to address multiple issues,” he said.
Litvak believes a “centralized” approach is needed at the federal and provincial levels that provides hospitals relief in the face of a crisis.
Canada’s health-care system is lagging behind some other high-income nations, according to some reports.
A 2021 report by the Commonwealth Fund ranked Canada’s health-care system 10th overall out of 11 countries. Norway was top-ranked followed by the Netherlands, Australia and the United Kingdom.
The United States, where health care is largely covered by private insurance, was ranked last.
Canada’s health-care system is “unique in the world” as it prohibits services by private insurance companies, according to a 2003 report published in the New England Journal of Medicine.
About two-thirds of the population have private health insurance, according to the Commonwealth Fund.
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However, this only covers services that are excluded from the universal health coverage such as vision and dental care, outpatient prescription drugs, rehabilitation services and private hospital rooms.
Other developed countries offer more flexibility and options.
In Australia, which like Canada has a universal health-care system, private health insurance may include coverage for hospital care, general treatment or ambulance services.
Australians also have the option to be treated as a private patient with 75 per cent fee coverage for hospital services.
In Germany, citizens who have the money can opt out of the country’s statutory health insurance and purchase “substitutive coverage.”
Even the U.K., which has a revered universal health-care system, offers private options.
“Canada’s health system is performing badly alongside similar countries,” said Day.
