August 3, 2024

Canadian Doctors Warn Against Private Medicine as a Cure for the System's Ills

	By Ian Austen

With perhaps 6.5 million Canadians finding themselves without a personal doctor and with seemingly endless waiting times becoming almost a norm for some medical procedures, private medicine is increasingly being pitched as a solution for those and other problems in Canada's public health system.

In Quebec, doctors have been leaving the public health care system for private clinics. Ian Austen/The New York Times

Private medicine comes in various forms. Ontario's Progressive Conservative government is planning to expand public funding for cataract surgeries and M.R.I. scans in private clinics and contract out hip and knee replacement surgeries.

In Quebec, doctors have increasingly been dropping out of the public medical system entirely to open private medical clinics where patients pay thousands of dollars each year to see a family doctor. Elsewhere, clinics are exploiting a loophole in current laws that ban payment for essential medical services by using nurse practitioners rather than doctors.

Canadians impatient with wait times have long flown to other countries for surgeries they pay for themselves.

And many hospitals across the country are coping with nurse shortages, which became widespread during the pandemic, by bringing in temporary nursing staff from for-profit agencies.

But now, a draft set of recommendations from the Canadian Medical Association says that it's time for governments to shut down payments for services that have long been covered by public health care systems and warns that private delivery of health care can lead to medical care of poorer quality at a higher cost.

"Anytime that you have a system in crisis, change is going to happen," Dr. Joss Reimer, a physician in Winnipeg who is president of the medical association, told me this week. "So I think it's a critical time for us to hear the voices of Canadians about what they want that change to be, because there are gaps in the system. There's no question that our public system is suffering."

The medical association formulated its recommendations after consulting 10,000 health care providers and patients through methods including town halls, surveys and focus groups.

Canada's system has always been a mix of private and public delivery. Physicians themselves aren't government employees but bill governments for their services while covering the costs of their offices and employees. Many services, particularly lab tests, have long been provided by for-profit companies that, again, charge governments for their services.

One major problem with turning to the private sector, Dr. Reimer said, is that it inevitably worsens shortages of doctors and nurses.

"When the solutions being put forward are to have private services fill the gaps, it's still the same health care providers who end up working in these private services," Dr. Reimer said, noting that the hospital in Winnipeg where she practices had closed some wards because of a lack of nurses, "yet we have nurses who are regularly moving to nursing agencies."

A view of the exterior of a building with a sign reading

Lab tests have long been provided by for-profit companies that charge governments for their services. Ian Austen/the New York Times

While health care is a provincial responsibility, the federal government's large transfer payments to the provinces to help their cover health care costs come with conditions laid out in the Canada Health Act. It prohibits doctors from charging for "medically necessary services" while also billing provinces. But only Ontario currently bars doctors from opting out of the public system.

About 780 doctors have quit the public system in Quebec, a province with a long waiting list for primary care doctors. By comparison, only 14 have left the system in the rest of the country.

Dr. Reimer said that the association had also reviewed all available research into how patients do when treated through publicly provided services compared with patients who are treated by private operators. The general trend, she said, was clear.

"Privately provided services, regardless of whether they're publicly or privately funded, tended to have higher costs and worse outcomes than the same service being publicly provided," she said. "When we looked at all of the literature, that was certainly the trend which made us want to be very cautious about putting money toward privately provided services."

She said that trend did not mean that all privately provided medical services were inferior or more expensive. But she said that governments would have to move carefully and analyze any shift toward private delivery from both financial and medical perspectives.

Private medical services are, of course, an ever-expanding business in Canada. Last month, an Ontario pension fund sold LifeLabs, one of a few large laboratory testing companies, to a large United States-based testing firm for 1.35 billion Canadian dollars.

In a report released in July, a report from Ontario College of Pharmacists, the professional licensing body for the province, warned that its members were struggling with increasing pressure from corporations that own pharmacies to increase business volume and profits.

That pressure, the report said, was affecting "the quality of care they want to provide to their patients."

It added that situation was creating "less of a focus on patient interests and more on profit."

Dr. Reimer acknowledged that the medical association's recommendations to governments would come up against lobbying from corporations that want to "get their foot more into the door of the health care system."

She added: "I can't say how they'll weigh these two different voices. But I do know that it's critical that physicians across the country, and all the patients that we talk to and that we represent, have a voice."

Trans Canada

David Keith, wearing a striped sweater, faces the camera with his hands in his pockets.

David Keith, who was raised partly in Ottawa and who studied in Toronto, suggests blocking the sun to limit climate change. Mustafa Hussain for The New York Times

This section was compiled by Vjosa Isai, a reporter and researcher based in Toronto.

The Canadian environmentalist David Suzuki rejected a risky idea proposed by the scientist David Keith — cooling the Earth using a pollutant to block sunlight — as "arrogant and simplistic."
Elaine Glusac, The Times's Frugal Traveler columnist, looks at how incentive programs reward tourists for good behavior. In British Columbia, Tourism Squamish provides refreshment vouchers to travelers in exchange for bags of garbage they collect along trails and at campsites.
The Times's Food staff tested coffee brands launched by celebrities like Tom Hanks, Emma Chamberlain and the Toronto-born singer and songwriter known as the Weeknd, offering mixed reviews.
A report by the Interior Department in the United States tallied, for the first time, the number of deaths of Indigenous children in government boarding schools.
The Canadian musician Alanis Morissette spoke to The Times about the parts of her life that give her strength and perspective, 25 years after the release of her second worldwide album.
An exhibition featuring the works of the Filipino American artist Pacita Abad arrives at the Art Gallery of Ontario this fall. "You will regret missing it," Andrew Russeth, an art critic for The Times, wrote in a review of Ms. Abad's first retrospective at MoMA PS1 in New York.
Best known for his opera productions, the Canadian director Robert Carsen took his talents to Salzburg, Austria, where his version of "Jedermann," an annual festival play, "stands head and shoulders above other recent stagings of the work," writes The Times's theater critic A.J. Goldmann.
And now, on to the Olympics. Here is a selection of stories featuring Canadian athletes you might have missed this week:
'We're All Living the Olympics Through TikTok Now' (The Times)
Who Leads the Medal Count? (The Times)
Kids at the Olympics: 'It's Honestly Kind of Insane' (The Times)
Olympic spying is just the latest example of Canada Soccer failing its players (The Athletic)
Canadian teenage star Summer McIntosh sets Olympic record, wins gold in 200-meter butterfly (The Athletic)

A native of Windsor, Ontario, Ian Austen was educated in Toronto, lives in Ottawa and has reported about Canada for The New York Times for two decades. Follow him on Bluesky at @ianausten.bsky.social.

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