The new health accord between Ottawa and the provinces provides more money, but it could also easily bring an even faster rollout of for-profit provision of health care across the country.
Right now, it’s pretty much up to the provinces to determine health care spending. But there are big differences between what they are doing and saying about for-profit care.
British Columbia in particular is taking a unique approach to some aspects of for-profit health care compared to other provinces—including Doug Ford’s Ontario. The recent BC throne speech, David Eby’s first as premier, was especially pointed about privatization not being the answer:
There are debates right now about the future of universal medicare around the country. Some jurisdictions are pushing for more privatization, allowing the wealthiest to buy their way to the front of the line. Make no mistake, that doesn’t fix the line. It would only lead to more costs and longer lines for the rest of us. And it is a dangerous step towards a two tiered system.
This sentiment was repeated in the February 2023 budget speech which stressed that Eby’s government would not be initiating budget cuts, would run a deficit to better meet care needs, and “instead of privatizing health care… would strengthen public health care.” This is important, but it still leaves the question about whether it refers only to services outside the public system, or about payment inside the public system. This is where much privatization occurs now.
BC recently made a very important step in bringing back into the public system 4,600 hospital workers whose jobs had been contracted out by the Liberal government in 2002. It also supported the public system in the courts through its case with Dr. Brian Day’s Cambie Surgical Centre over the issue of private for-profit centres (Day is a “self-described champion of privatized health care”).
In contrast, Ontario Premier Doug Ford champions the shift to the private for-profit sector for many surgeries by saying, “you can’t have endless debates about who should deliver health care. The way I can describe it, you have a dam, you have a log jam, are you going to just keep pouring the water up against the logs? Or are you going to reroute some of the water and take the pressure off the dam? You see what happens when the dam has too much water, it breaks.”
This “rerouting” will mean using public funding to move as many as 50 percent of surgical procedures out of hospitals and into private clinics, any of which might be for-profit. The extra-billing of patients beyond the payment by the province is a routine practice of existing for-profit clinics, something to be expected in the new clinics as well. So far no government is being systematic in preventing this from occurring. Ford’s health minister says, “I wouldn’t call it upselling, I would call it patient options.”
Ford is also turning toward the private for-profit sector for increases in long-term care, specifically by designating that one-half of the 60,000 newly funded beds will be for-profit. The scale is smaller in BC, but new for-profit private contracts continue to be awarded, such as the 90 new beds for Vernon. The for-profit nature of the contracts is concealed from the public by announcing that the projects are publicly funded.
Added to these aspects of for-profit action in health care is the escalation of contracting-out of services and building through public-private partnerships.
Health care delivery is changing throughout the country with new incursions of for-profit care expanding rapidly. Even companies that traditionally have been non-health care providers are delivering direct patient care for the general public. Most recently, the CAA Maple app promises to cover the slack in the system from doctor shortages, joining other private companies including Telus in providing access to doctors and other health professionals.
In one attempt to stem the tide, the BC government is taking Telus to court over its creation of a two-tiered medical system. It costs $4,650 the first year and $3,600 each subsequent year to join the Telus LifePlus program, a fee-based service which “includes 24/7 physician coverage.” Reports indicate that some people were told their family doctor now works for Telus and that it would be necessary to enroll in the program to continue in their practice. Currently, more than one million people in BC (a province of five million) do not have a family doctor.
In an attempt to control some for-profit delivery, the federal government recently announced it will cut transfers to provinces that allow for-profit companies to bill for medically necessary services that are covered by provincial schemes. It is beginning by cutting $76.5 million to seven provinces for diagnostic tests costs that patients were charged.
This is an important renewed promise to uphold the Canada Health Act and may be helpful to provinces that want to prohibit extra billing. But the tricky part here is that there is so very much that can be worked around by for-profit providers, especially by contracting doctors or nurse practitioners from out of province.
The best approach will be to expand the public sector as rapidly as possible. As system designs are being considered, bringing general practice doctors into community clinics would be a major advance. That would also address one of general practitioners’ main complaints: too much office administration and paperwork. But also expanding the kinds of medical needs that are covered under the public medical plan is crucial.
Marjorie Griffin Cohen is a feminist economist who is Professor Emeritus at Simon Fraser University. She is a part of thecareeconomy.ca.