For some, the words “private health care” suggest a threat to Canada’s public system. To others, they represent a possible solution to that system’s growing problems, including long wait lists, crowded emergency rooms (when they aren’t temporarily closed) and overworked staff. What’s the right balance?
The Canadian Medical Association (CMA) is holding a series of consultations to gather input from health care users, physicians, medical learners, providers and policymakers on the issue. They include four town halls in partnership with the Globe and Mail, starting in Toronto on Sept. 8, followed by Montreal, Vancouver and Halifax.
Dr. Kathleen Ross, the new president of the CMA, is a leading voice in this important discussion. A family physician in Coquitlam and New Westminster, B.C., she has front-line experience with the country’s health care crisis as well as a background in establishing policy as a past president of Doctors of BC. In advance of the Toronto event, Dr. Ross spoke about the consultations and what the CMA hopes to achieve.
Why did the CMA decide to launch this series of discussions on public and private health care?
The issue is top of mind right now because Canadians are worried about accessing health care in a timely manner. There’s been an undertone [of wondering] whether there’s a role for private care in the public system to improve access.
Who will you be consulting?
To have a fulsome discussion about the role, if any, of private care in our publicly funded system, we’re going to need to hear the perspectives of people affected by the changes across the country. We hope to do that with the town halls. In addition, we’re going to be consulting with people with lived experience, physicians, medical learners and other health professions.
Don’t we already have private health care delivery in Canada?
We do. CIHI [Canadian Institute for Health Information] recently issued a report that showed the public funding for health care in Canada sitting at approximately 72 per cent, compared to 28 per cent that’s funded privately.
When most of us talk about private health care, we’re thinking about for-profit companies delivering care that patients pay for 100 per cent out of their pockets. This certainly can happen, with physiotherapy, mental health, dental care, eye exams, prescriptions and other services. Many Canadians carry private insurance, often provided by employers, that picks up a portion of the tab.
We also see governments outsourcing health care services to private providers. For example, for cataract surgery, flu shots, blood tests. These are provided to patients at no cost, but they’re delivered by private entities.
It’s important that we discuss how the system works now and what we mean when we use terms like “private health care.” We also need to understand what the picture looks like across the country, because each province and territory has different rules regarding the mix of public and private care delivery.
Who decides whether we increase the role of private health care providers?
The Canada Health Act says every Canadian should have access to medically necessary diagnostic tests and care without having to pay out of pocket. It’s up to the provinces and territories to determine whether those services are delivered in a public facility or in partnership with a private enterprise.
There has always been a concern that private health services will lead to a two-tiered system, where people can pay their way to the front of the line, so to speak. What do we know about the impact of private health funding and delivery on access to care?
We do know Canadians are concerned about a health care system with several levels of access. But frankly, the impact is an area that we need more research on, particularly on what happens to the public health systems when the role of private care is increased. Does it increase or diminish access? What about the quality of care and outcomes? What happens to our human health resources? As you know, we have a very limited pool of health care providers to start with.
Would shifting the balance of public and private health care help with the lack of primary care physicians, especially in remote and rural areas where there’s the greatest need?
We really don’t know, but we definitely need to look to other jurisdictions. For example, in Australia, which has a more defined partnership between public and private, there really hasn’t been a significant change in their access to primary care. I think what is clear is that moving to private payer options has not solved the human health resources and access issues around primary care, particularly in rural and remote areas, where both Australia and Canada, and many other jurisdictions globally, struggle.
What about wait-times for surgeries and other medical procedures or the problem of overcrowded hospitals?
We know that there is still excellent quality health care being delivered across Canada – if you need critical care, you will get it. It’s when you have to wait for procedures or surgeries that are less urgent that Canada needs to look at improving access across the board. We’ve seen many governments starting to contract with private entities in hopes of reducing their wait lists, for example with cataract or knee surgeries.
What will the CMA do with the results of these consultations?
We are going to inform our recommendations for policy and advocacy at a national level.
How can Canadians get involved in the discussion?
They should speak up when they have the opportunity and share their experiences, both with those providing care, but also with the political representation in their area. We’re looking at developing policy that is reflective of what Canadians are expecting from their health care system. We’re hoping that honesty and transparency in these discussions will lead to effective change.
The Public-Private Health Care series takes place Sept. 8 in Toronto, Oct. 23 in Montreal, Nov. 23 in Vancouver and Jan. 25, 2024, in Halifax. For more information and to register, go to https://globeandmailevents.com/publicprivatehealthcareseries
A recent report by the Canadian Institute for Health Information (CIHI) showed public funding for health care at 72 per cent, with 28 per cent funded privately.
This includes a range of services traditionally not covered by public insurance, including physiotherapy, mental health, dental care, eye exams and drug prescriptions. Canadians pay out of pocket for these services, or through private insurance, often provided by employers. Other services, such as home care, are publicly funded to a certain level, but patients may need to pay additional expenses themselves.
Increasingly, governments have also turned to private companies to provide a range of publicly covered services, from flu shots and blood tests to cataract surgery. Since the pandemic, many of Canada’s public hospitals have relied heavily on for-profit staffing agencies to combat the burnout among nurses and other health care workers – at what critics claim is an exorbitant cost.
Advertising feature produced by Globe Content Studio with the Canadian Medical Association. The Globe’s editorial department was not involved.