Health: Ontario’s plan to increase use of private clinics renews debate about the current system

By Akinbiodun Kehinde Tosin

Staffing shortages have forced some hospital emergency rooms to close this summer, and others have turned to private agencies to fill in the gaps.

This is an excerpt from Second Opinion, a weekly analysis of health and medical science news.

The current staffing crisis in health care has reignited debate over privatization of the Canadian system — and while more needs to be done to take the pressure off 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-care system that included increasing the number of publicly funded surgeries performed at 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 news 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.

When asked about the role of private clinics recently, Ontario Health Minister Sylvia Jones said that the public should not be afraid of ‘innovation’ in the health-care system.

Yet for-profit clinics for surgeries and other medical practices have existed to varying degrees across Canada for decades, and commercial agencies have been quietly filling staffing shortages during the pandemic — at a growing cost to hospitals and taxpayers.

Proponents argue some privatization would take pressure off the public system and better triage care, while those opposed worry it would siphon off resources and increase inequity among Canadians.

“Right now, we find ourselves in a really challenging situation, because the health-care system is currently not functioning well — and I think that’s becoming more apparent day by day,” said Dr. Katharine Smart, president of the Canadian Medical Association (CMA).

“Privatization always is one of the things that people bring up in that conversation,” she said. “But I think what we really need to be considering is how would that actually improve service delivery for Canadians, to suddenly have a private, for-profit model?”

Canada is facing a critical shortage of family doctors, with millions of Canadians without access to primary care because of retiring physicians and fewer medical school grads choosing the specialty due to a lack of resources and high overhead costs.

The pandemic has also exacerbated a lack of access to emergency care and increased wait times for surgery, with close to 600,000 fewer surgeries performed between March 2020 and December 2021, compared to 2019, according to the Canadian Institute for Health Information (CIHI).

Almost half of adults across Canada’s 10 provinces had difficulty accessing health care in 2020 and 2021, while close to 15 per cent said they didn’t receive the care they needed at all, according to a 2021 survey from Statistics Canada.

Family physicians Dr. Kamila Premji and Dr. Rita McCracken discuss the shortage of family doctors in Canada and what can be done to ease the situation.

Private clinics have moved in to try to fill that gap in some provinces, including Quebec and Nova Scotia. Others are pushing back against the notion of offering more private health care.

In British Columbia, the province’s highest court recently upheld a lower court’s dismissal of a Vancouver surgeon’s challenge of the Medicare Protection Act, ruling that bans on extra billing and private insurance do not violate charter rights.

As it stands, Canada’s health-care spending is divided between the public and private sector at roughly a 75-25 split, and at a cost of about $6,666 per Canadian, according to CIHI. Private health-care services are paid for by patients primarily out of pocket, as well as through private insurance.

The country was projected to spend more than $300 billion on health care in 2021, which represents nearly 13 per cent of the GDP. That puts Canada roughly on par with other wealthy countries. (The United States spends the most on health care of any country in the OECD.)

Dr. Adam Hofmann is owner of Algomed, which has private clinics in Quebec and Nova Scotia, where it charges clients a subscription fee of $22 per month out of pocket, plus $20 per visit. Hofmann said while he was once a staunch defender of a publicly funded health-care system, he now believes private clinics are part of the solution

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