The case against private-pay healthcare

Every day, I see people who are struggling with access to primary care or people who bring their mothers to the hospital, to the emergency department because ther’re on a wait list for a hip replacement, and they’re languishing and struggling for months and sometimes even years. And I understand in those moments that people are frustrated. The status quo is not working for people. I understand in those moments when you’re stressed about your health and the health of your loved ones, that people put the blinders on, they stop caring about the system, and they care about whether they and their loved ones can access care. I think it’s natural in those moments to wonder, “If I can afford it, why can’t I pay privately to access care quicker?” But just like I also understand when a patient comes in requesting a full body MRI because they’re concerned about a new, strange symptom, the evidence doesn’t support it, and our job is to listen to our patients to understand the symptoms that they’re coming in with that they’re worried about, but to create the right management plan based on the evidence. Read: Does the health system need more private care—or less? The evidence for the symptom of poor access is very clear. Private pay is not going to help. There is a wealth of evidence out there, but I’ll give you one quick example of what’s happening right now in Quebec. Like everywhere in the country, we’re facing a primary care crisis there, but some doctors are leaving the public system altogether and charging patients privately for access to primary care. And the results of that are extremely predictable. You cherry pick the healthiest and the wealthiest out of the public system, you treat them privately. And because we have a finite resource in the number of primary care doctors, our public system now has less resources, and you’re seeing more complex patients with less resources to actually address their issues. And now, you’re looking at your colleagues who have left for the private system, who are making more money for less difficult work. And as people burn out, I’ve seen people burnt out all across the province, their results are again predictable. People are leaving the public system and that cycle just worsens and continues. In the last decade, double the number of family doctors have left the public system in Quebec to work in a private one, and that cycle is only going to perpetuate and continue. So with the wealth of evidence out there, why are we continuing to have this discussion about privatization? I sometimes joke, it feels like a national pastime for us. Every few years this discussion comes up. And I think part of it is that we compare ourselves to some of our peer countries, places like the U.K., Sweden, France, Germany, places that have a small, highly regulated parallel private system, and we think, “Maybe that’s what we need.” But where we’re comparing those countries is not on a lack of private healthcare, it’s that we have too much private healthcare compared to those systems. Thirty per cent of our system is privately funded already, and those peer countries we compare ourselves to, they sit around 15%. They cover more things than we do, a much more rational basket of services like dental care, pharmacare, home care. But for some reason, we latch onto this idea that it’s that small parallel private system that’s the difference when it really, really isn’t. One of the major differences between high-functioning healthcare systems and what we do is that they don’t just fund care, they actually coordinate it and deliver it. Former CMA president Dr. Katharine Smart talked mentioned at the Health Summit that our governments have to take ownership of the care that we’re actually delivering. Right now, I could go down to Bay Street in Toronto and set up another walk-in clinic. And through fee for service billing, the Ontario government will pay for that care, but that’s not where the need is right now. But if we took our system seriously, and we matched the resources we’re willing to provide with the actual needs of the communities we’re trying to serve, well then we can realize visions like the one that Dr. Tara Kiran talked about at the Health Summit where every Canadian has access to a primary care team. Just like we guarantee access to public education for every child. Those are the types of modern solutions we need to this issue of access instead of rehashing old debates about privatization and private pay. Just imagine instead of as a family doctor being expected to know every single surgeon in your area and their individual wait lists, you could refer to a centralized referral pathway, and your patient could see the next available specialist in the region that they’re able to travel to. Those are the types of solutions that are going to help that mother that I see in the emergency department get the hip replacement they need in a timely way. Those are the types of solutions that are going to help access in a way that’s equitable and the most efficient use of our resources. I see failures of our healthcare system every day in the emergency department. And sure, I see failures of our public healthcare system, but very often I see failures of our private healthcare system. I see people come in with bad facial infections because they couldn’t see a dentist for a simple toothache, and I see people with bad diabetic ketoacidosis who end up in the ICU to great risks themselves and great expense to the system because hey couldn’t fill a simple insulin prescription. So as the CMA embarks on these discussions (about private care), I hope we can leave some of these old, outdated myths behind around private pay. In fact, I think we should be talking about publicizing our healthcare system, and I think we should talk about how we better coordinate and deliver care, whether that’s publicly delivered care or privately delivered care that’s on a not-for-profit basis, and what role, if any, does privately for-profit delivered care play? Those are the types of modern discussions we need to have as the CMA embarks on the present day conversation about how we improve access to care in our system. And I think we can leave behind these old myths like private pay. Dr. Hasan Sheikh is an emergency and addiction medicine physician in Toronto and a board member with Canadian Doctors for Medicare.

The case against private-pay healthcare

Register for free access or login.

Related Topics