Private medicine, public good

Canada should follow Europe’s lead and allow people to pay for
their own medically necessary care
DR. CHARLES SHAVER

FIRST POSTED: SATURDAY, SEPTEMBER 24, 2016
06:56 PM EDT

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Is there any role for increased private health care
in Canada?
In Vancouver, Dr. Brian Day, an orthopedic
surgeon and former president of the Canadian
Medical Association, has launched his longawaited court challenge of the Canada Health
Act.
The main issues are whether Canadians should
be allowed to pay privately for “medically
necessary services”, already covered by their
provincial health plans, and whether doctors
should be permitted to charge outside these
plans for “private” services.
Unlike Americans, Canadians enjoy a universal, single-payer health care system that minimizes administrative
costs and should, in theory, cover everyone — regardless of previous illnesses or changes in medications.
While provinces clamour for increased funding from a new federal-provincial health accord, even federal Health
Minister Dr. Jane Philpott admits “innovation” is required.
Yet because our governments blindly and selectively pay homage to certain parts of the Canada Health Act
(CHA) while ignoring others, Canadians fail to enjoy the health care efficiencies found in most European
countries as well as Australia.

Violations of the CHA have occurred in many provinces, but only British Columbia has been financially
penalized.
For example, Saskatchewan last March announced that two MRI clinics in Regina would offer “private” scans
for a fee.
Quebec has many private clinics, including one that performs 200 joint replacements per year. About 30% of
Quebec patients come from other provinces.
Quebec doctors reportedly charge patients $50 million to $90 million per year in added fees. The Quebec
government has finally abolished this practice, but it won’t take effect until next year.
Quebec also refuses to respect Section 11 of the CHA. The result is that it does not pay host province rates to
physicians on behalf of Quebec residents requiring medical care in other provinces.
For 32 years, no Liberal or Conservative federal health minister has had the backbone to enforce the law.
Ironically, patients from Eastern Ontario can obtain an MRI at a private clinic in Gatineau, Quebec in only 24 to
48 hours for $745.
This is legal, as health care is regarded as a “provincial” matter.
Despite denials by politicians, a “two-tier” health care system has always existed in Canada.
Federal prisoners, WSIB patients, members of the military and RCMP, politicians, and professional athletes
usually obtain more timely care — often at private facilities.
In that context, shouldn’t all Canadians be able to spend their discretionary income on their own health?
If one does not live near an interprovincial border, and if one is not a member of one of these special groups, is
the only option to go to Buffalo, Syracuse, etc. and provide employment to American doctors and nurses and
profit to U.S. hospitals?
Those who oppose any privatization of medicare claim physicians would leave the public system.
Yet, according to a 2013 survey, 15% of surgeons considered themselves under-employed and 64% cited poor
access to operating rooms.
With frozen hospital budgets, this will likely not improve.
If orthopedic surgeons had access to additional “private” operating room time, it could shorten wait times for all
Canadians.

It could also bring in extra revenue for hospitals, particularly if they were able to operate electively on
Americans and other foreign patients.
All of this would help relieve the strain on provincial health budgets.
To minimize the risk of MDs confining themselves to the private system, they could be required to work,
perhaps 25 to 30 hours per week, in the public system, in order to receive reimbursement for malpractice
insurance.
Most physicians would still likely practice entirely within the public system.
They deserve fair treatment.
That’s why Dr. Philpott should amend the CHA to make binding arbitration mandatory when provincial
negotiations with doctors fail, as they have in Ontario.
We need to amend and modernize the CHA.
Where wait times are excessive, certain diagnostic services and surgical procedures should permit private
access for all Canadians, not just a select few.
This would maximally utilize expensive equipment and provide new employment for nurses, technicians and
surgeons. Canada can offer high-quality care that is much less costly than in the U.S.
It’s time we recognized this and utilized it to improve the financial situation for hospitals and health care
providers, as well as shorten wait times for Canadian patients.
Ottawa should then enforce all sections of the CHA on all provinces and territories.
If not, the CHA will increasingly resemble the Norwegian Blue Parrot skit of Monty Python fame.
That is, dead in reality, while our politicians, to suit their own purposes, keep pretending that it is alive.
Dr. Shaver, an Ottawa physician, is Chair of the section on General Internal Medicine of the Ontario
Medical Association.