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In a recent multi-part series that included an opinion piece headlined Double-dipping doctors defy the spirit of Canadian health-care, the Globe and Mail alleged that physicians working in private medical clinics are billing both the public system and the patient for the same service.
Shortly after, Federal Health Minister Jane Philpott and B.C. Health Minister Adrian Dix announced an audit would be conducted of three B.C. private health clinics for possible violation of the Canada Health Act’s prohibition against private billing for medically necessary services.
Meanwhile, B.C., together with the federal government, is spending tens of millions of dollars fighting a lawsuit launched by Dr. Brian Day’s Vancouver-based Cambie Surgery Centre. Day’s suit claims that denying Canadians the right to access private care, a right available to the citizens of virtually every other country, is a violation of the Canadian Charter of Rights and Freedoms.
Much could be said about Globe’s distortions but the most fundamental is the false and misleading use of the term double-dipping. When surgeons operating at private clinics bill the public system, the amount is the same as if the surgery was done at a public hospital.
The patient’s fee is to cover expenses incurred by the private clinic including medical supplies, nurses, technologists and other support and administrative staff. These same costs are incurred by patients undergoing surgery in public hospitals, but the difference is that they are paid from the taxpayer-funded provincial hospital budget and not by the patient. So, when a patient opts for private surgery, the public system actually saves these very substantial expenditures and wait-lists are shortened.
If Philpott were to achieve her avowed goal of shutting down Canada’s private clinics, those patients and the costs they pay would be thrown back onto an already overstretched public system, further lengthening wait times that are longer than in any other developed country. As if all this isn’t enough, Philpott has stated that she’ll also investigate private MRI and other diagnostic clinics for possible violations of the Canada Health Act. And since her jurisdiction is national, her actions would apply nationwide. The only thing standing in the way is Cambie Surgery’s Charter challenge.
Day, an internationally acclaimed orthopedic specialist, founded Cambie Surgery more that two decades ago when his public hospital operating-room allocation was reduced to just five hours per week, preventing him from treating his long list of patients. Since then, public hospital operating room allocations have diminished further. Ironically, it’s legal for private clinics to provide cosmetic and other non-essential surgeries, but unless a patient commits the heinous crime of paying for surgery out of their own pocket, a medically necessarydiagnosis is a sentence to suffer on long wait-lists.
Almost every Canadian has a family member or friend suffering on everlengthening wait lists. That’s the human toll. But what about the economic and social cost? Across Canada, health care consumes more than 40 per cent of provincial revenues, reducing funds available for education, social programs and infrastructure.
A 2017 Fraser Institute study, The Private Cost of Public Queues for Medically Necessary Care, calculated that the 973,505 Canadians waiting for treatment lost $1.7 billion last year in wages alone. And that number would be twice as high if the lost time before seeing a specialist after general practitioner referral were included. Taken together, those wait-times averaged 20 weeks in 2016.
As wait-times grow, so do the number of Canadians who travel abroad for treatment.
A related Fraser Institute study found that 63,459 persons left the country for medical care in 2016, up nearly 40 per cent from the previous year. Meanwhile, Canadian physicians cannot treat patients because they can’t get operating-room time and scanning services needed to make a diagnosis.
Herein lies an enormous economic opportunity. So-called medical tourism is a huge and growing business. Third world countries such as India and Thailand attract thousands of foreign customers, including Canadians. Removing prohibitions against private care would reverse the flow of money going to international private hospitals, better utilize our world-class health care professionals and foster job-creating investment in one of the world’s fastest growing sectors. Canada’s universal no-charge public health care system would remain sacrosanct, while Canadians who choose to access the private clinics would help reduce both wait-times and costs.
Gwyn Morgan is a retired Canadian business leader who has been a director of five global corporations.
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