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The current healthcare employment crisis has reignited the debate over the privatization of the Canadian system – and while there is more work to be done to relieve pressure on hospitals, critics say more private care is not a “simple solution”.
This week, Ontario Health Minister Sylvia Jones reveal a plan To help stabilize the county’s health care system that included an increase in the number of publicly funded surgeries being performed at existing private clinics, though it declined to provide details about the specific facilities that would be involved or the surgeries that would be covered.
“Health care will continue to be provided to Ontarians through the use of the 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 potential solution to the employment crisis you are feeling across the country.
Yet for-profit clinics for surgeries and other medical practices have existed to varying degrees across Canada for decades, and commercial agencies are quietly filling staff shortages during the pandemic — at an ever-increasing cost to hospitals and taxpayers.
Proponents argue that some privatization would take pressure off public order and better triage arrangements, while opponents fear it would draw resources and increase inequality among Canadians.
“Right now, we find ourselves in a really challenging situation, because the healthcare system is not working well right now – and I think that is becoming more and more evident by the day,” said Dr. Catherine Smart, president of the Canadian Medical Association. CMA).
“Privatization is always one of the things that people bring up in that conversation,” she said. “But I think what we really need to think about is how can that actually improve service delivery for Canadians, to suddenly have their own for-profit model?”
Private clinics aim to fill gaps in care
Canada face The acute shortage of family physicianswith millions of Canadians deprived of primary care due to doctors’ retirement and Fewer medical school graduates choose specialization Due to lack of resources and high overhead costs.
The pandemic has also exacerbated the lack of access to emergency care and increased waiting times for surgery, with nearly 600,000 fewer surgeries performed between March 2020 and December 2021, compared to 2019, according to the Canadian Institute of Health Information (CIHI).
Nearly half of adults in Canada’s 10 provinces had difficulty accessing health care in 2020 and 2021, while nearly 15 percent said they did not receive the care they needed at all, according to the Survey 2021 from Statistics Canada.
Watch | What is the reason for the shortage of family doctors in Canada?
Private clinics have moved to try to fill this gap in some provinces, including Quebec And the Nova Scotia. Others resist the idea of providing more private health care.
In British Columbia, the province’s highest court recently upheld a lower court Vancouver surgeon sackedChallenging the Medicare Protection Act, which holds that prohibiting extra billing and private insurance does not violate Charter rights.
As it stands, healthcare spending in Canada is split between the public and private sectors roughly 75-25 split, and at a cost of about $66,666 per Canadian, According to CIHI. The costs of private healthcare services are paid for by patients primarily out of their own pockets, as well as through private insurance.
The country was expected to spend more than $300 billion on healthcare in 2021, which would be roughly 13 percent of GDP. This puts Canada almost on a par Other rich countries. (The United States spends more on health care than any OECD country.)
Dr. Adam Hoffman is the 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. Hoffman said that while he was a staunch advocate of a publicly funded health care system, he now believes private clinics are part of the solution.
“A significant number of patients who end up in the emergency room are there because of conditions that can be treated or prevented in an outpatient primary care clinic,” he added. CBC the home. “And these patients almost all over the world do not have access to primary care.”
Janice McKinnon, a professor of public policy at the University of Saskatchewan and a former provincial finance minister, said these kinds of private options should be explored more broadly as Canada seeks to solve health care challenges.
“We have to do everything we can to make the system more efficient, more cost-effective, and more accessible to people,” she said. the homeadding that other countries, especially in Europe, have developed models in which public and private systems can coexist.
“No government says: ‘We don’t want to reform public order, we want to create a separate system. They say we need to reform public order and we see private options as a way to do that.'”
Privatization is not a simple solution
Colin Flood, a research chair in health law and policy and a professor at the University of Ottawa, has looked at health care systems around the world and says private care tends to make access more difficult for low-income residents.
Feud described privatization as a “zombie solution” that we “pull out all the time, rather than focus on how to reform the public health care system.”
“It’s not a simple solution,” she said. “Countries with public and private regulations spend a lot of time trying to figure out how to regulate the private sector [sector] So that it does not absorb all the resources from the public health care system.”
In general, she explained, private clinics tend to target less complex procedures — such as knee and hip surgeries — but the public system still relies on emergency services and complex treatments for conditions like cancer and heart disease.
“So you’re diverting employment…not only to the relatively small percentage of the population that can pay for that or have private insurance, but you’re also diverting them away from really important care,” she said.
Maud LaBerge, professor of health economics at Laval University in Quebec City, said Ontario’s plan to fund private clinics with public funds could be a more effective way to provide the service, depending on the cost, which is ultimately borne by taxpayers.
“This is an aspect of the negotiation between the government and those clinics,” she said. “As long as the patient does not have to pay. … If a clinic can do something really good – as it is done in a hospital or in public places – there is no problem with having such private and specialized clinics. If the patient has to pay, Then it brings with it equity issues.”
Hiring staff from private temporary agencies has not seemed to solve the crisis in Ontario, with some hospitals paying millions more to such companies to help intensive care units and emergency rooms, at an hourly rate more than twice the rate for union nurses, as first reported before toronto star this week.
“Where’s the oversight of our tax money?” said Dr. Michael Warner, MD, medical director of critical care at Michael Garron Hospital in Toronto. “Then what is this money that is not being spent because it is being spent on nurses?”
Watch | Critics are sounding the alarm about Ontario’s reliance on private nursing agencies:
University Health Network of Toronto (UHN) spent just over $1 million hiring nurses from various agencies in 2018 — but that increased to more than $6.7 million in 2022 alone, more than $4 million of which was associated with hiring nurses from the sector Special to work in intensive care units. .
“What we’ve seen during COVID is that these agencies are charging a lot more, and I’m not sure where their money is coming from, but hospitals are charging much higher hourly rates,” Warner said. “What they did during the pandemic was predatory and exploitative.”
General system conversion?
Proponents of privatization say Canada’s health care system desperately needs to be open to new ideas, with Jones, Ontario’s health minister, saying last week that Ontarians should not be afraid to “innovate.”
But critics say there is little evidence to suggest that the situation is improving with the private services we already have – although they cost much more – or that more of them will help.
“While there may be ways to improve the system, certainly, through innovation … we have to be clear about exactly what we are privatizing and how that will cost less and produce better results,” Warner said.
“It makes more sense to change the public system than to forgo private healthcare.”
CMA’s Smart said previous examples of private companies providing health care in Canada “eliminate the easiest and simplest areas” and fail to develop a continuous and meaningful patient-physician relationship.
“It doesn’t do anything for patients who have chronic and complex needs; it doesn’t do anything for patients who may be challenged by the social determinants of health,” she said. “These people were left behind, because of a public system that was under-resourced.”