Stand up for health care or risk letting it blow away – Opinion – Stand up for health care or risk letting it blow away: For-profit clinics are changing our public system as they push for two-tier care
October 24, 2008. Doris Grinspun and Danielle Martin

As politicians and average citizens turn the page on the federal election, addressing serious economic turbulence becomes job one.

Canadians are rightfully anxious as they watch financial market upheaval, major job losses in manufacturing, a credit crunch, falling housing prices, and an impending economic downturn. We are still privileged compared with our neighbours to the south who face the loss of their health insurance when losing their jobs. Or when major illness strikes, they also face financial ruin.

Canadians trust that they have secure access to hospital and other major health services, regardless of their health, job or financial status. But with emerging two-tier health care and the first serious forays of U.S.-led multinational health companies into Canada, we should not be complacent about our most cherished social program.

Research shows that half of the 1.5 million American families who file for bankruptcy every year do so due to medical causes. This fact speaks volumes about why Canadians regard medicare as one of this country’s best assets. Health care – its costs and our access to it – is intrinsically connected to our personal security and our economic well-being.

Earlier this month, the Ontario Health Coalition (OHC) released a report in which it identified for-profit health-care clinics across Canada and attempted to measure how their approach to selling health care is affecting Canada’s public health-care system.

The report identified 130 for-profit health-care clinics across the country selling surgeries, MRIs and access to physician care. Most of these clinics have opened in the last five years. Notably, is changing from small local companies to chains and U.S. companies that are aggressively pushing two-tier health care and seeking government-funded contracts.

The OHC documents evidence to suspect 89 clinics in five provinces of potentially violating the Canada Health Act requirement that governments protect patients from extra-billing and two-tier care. Most clinics are maximizing revenues by both charging patients and billing their provincial health plans. In at least two provinces, for-profit clinics have taken scarce health professionals out of local hospitals causing the hospitals to reduce services.

Perhaps most importantly, the prices being charged by for-profit clinics for health-care services are too high for the vast majority of Canadians to afford – $13,000 to $20,000 or more for knee surgery for instance, or up to $3,000 for enhanced access to physicians in “boutique” clinics.

The trend toward more private health care is neither inevitable nor unstoppable. In Alberta, Manitoba and Ontario, governments of varying political stripes have rolled back contracts with private, for-profit clinics, opting instead to increase capacity in public hospitals where access is improved on an equitable basis. The bulk buying power of governments works to keep down the extraordinary surgical, MRI and physician costs that are levied on patients when they are forced to pay out-of-pocket. In Ontario, for example, non-profit hospitals are paid $474 for each cataract surgery while for-profit clinics charge patients $1,200 to $2,000 for the same surgery with a different lens.

As the OHC report indicates, governments must be diligent if two-tier health care is to be stopped. The report indicates that in our province one can find private, for-profit surgical clinics, such as those selling laser eye surgeries, also performing medically necessary cataract surgeries. Patients are encouraged to pay upfront for “faster” service than they would receive in a public hospital. In some instances, these companies market their services saying that patients are paying for the lens rather than the surgery and that a follow-up visit is included in the fee.

It appears that Ottawa has abdicated its responsibility to protect patients from extra fees by enforcing the Canada Health Act. In turn, most provincial governments have failed to create adequate regulatory and enforcement regimes to control an emerging for-profit health-care industry that is undermining the equity and fairness of our public health-care system. Only the concerted efforts of both provincial and federal governments can put a stop to this trend. The role the federal government plays with regard to this issue will be critical.

The fact that the major political parties paid lip service to health and health care during the recent campaign cannot continue once MPs return to work in Parliament. Severe shortages of health professionals and personal support workers are damaging our capacity to provide needed care across the country and are affecting access in all sectors. The lack of a national pharmacare program leaves many Canadians without needed medications. Ottawa has a significant role to play in improving and expanding medicare – and an equally significant role in putting a stop to the erosion of our publicly funded system. Minority governments work best when parties collaborate to pursue the public interest. Let’s see some concrete plans to make this happen.

Canadians have the right to know where their government and the opposition parties stand on protecting universal health care and prohibiting the extra-billing of patients. Will they work together to step up efforts to monitor and enforce protections for Canadians or will they allow Canada to slide deeper into two-tier care that will benefit a few at the expense of many?

Doris Grinspun is a registered nurse and the Executive Director of the Registered Nurses’ Association of Ontario (RNAO).

Danielle Martin is a family physician and Chair of Canadian Doctors for Medicare.

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