We are walking down the dangerous path of health care privatization

Posted on November 21, 2023 in Health Delivery System

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TheStar.com – Opinion/Contributors
November 19, 2023.   By Michelle Cohen Contributor

Does the privatization gold rush improve overall societal health or is this yet another symptom of our decaying system?

When Numinus, a Vancouver-based psychedelic therapy company, acquired Neurology Centre of Toronto in 2021, its CEO enthused that “[w]ith neurologic care in the Numinus portfolio, we continue to thoughtfully grow our patient and revenue base.”

However, two years later some physicians (myself included) were dismayed to learn that the clinic was closing its publicly funded neurology services to focus on privately funded ketamine and psilocybin therapy.

Neurology is an essential medical specialty that is undersupplied, which means multi-year waits. And while psychedelic therapy holds promise for mental illness, it’s certainly not a replacement for neurologist care. It’s also expensive, with ketamine treatments starting at $400. By contrast, an initial neurology consultation costs the province $184.40.

The pace of privatization seems to be accelerating, with jurisdictions like Ontarioand Alberta expanding private pay services in various forms. More recently, former Ontario Health Minister Christine Elliott registered as a lobbyist for Clearpoint Health Network, which owns a chain of private surgical facilities and was acquired by the private equity fund of Kensington Capital Partners in 2019.

The province has been steadily increasing funding to one of Clearpoint’s facilities since 2020, two years before Elliott left government. Not only has there been a notable increase in corporate investment in health care, the seeming complicity of government marks a new and disturbing phase: a privatization gold rush, where financial speculation runs rampant, free of regulatory controls or even public scrutiny.

Another example is private primary care clinic Parallel Health in Newfoundland and Labrador. It’s owned by Seafair Capital, a St. John’s-based venture capital firm that has stepped into the broader health care marketplace with “delivery of community, home and residential care.” Numinus also has a finance pedigree, and while its CEO reports a “deep understanding of the psychedelic industry” based on personal experience, his formal background is not in health care but rather investment and banking.

Knowing this it’s unsurprising that Numinus touts itself as “the first publicly traded company in Canada to be granted a licence by Health Canada” to sell psychedelics. That Numinus accepts cryptocurrency as payment seems a perfect encapsulation of its corporate investment origins.

The plethora of new private clinics in Canada often exploit medicare loopholes to maintain legality. While physicians are not permitted to sell publicly funded services for a private fee, nurse practitioners are under no such restriction and provide many of the same services as family doctors.

Similarly, medicare restrictions on physicians are provincially and territorially imposed, so many virtual clinics skirt the rules by employing physicians licenced in a different jurisdiction than the patient lives. Resolving these loopholes is not impossible — simply fold nurse practitioners into the same medicare legislation physicians work under and bring in nationwide physician licencing. Yet there seems to be no appetite on the part of health ministries to address these issues.

Research from 2022 on the growing crop of private primary care clinics noted a trend toward profit-driven services. These clinics tend to be urban, often sell alternative health and cosmetic services and emphasize convenience, personalized care and health optimization. Taken together, these factors suggest a wealthier clientele.

While what are sometimes called “executive” or “concierge” clinics aren’t new, what has changed since the COVID era is the proliferation of virtual care clinics, many of which place highly questionable wellness services alongside essential primary care. This transforms the health care experience from one where a patient is guided by a trusted medical expert to one where a consumer purchases care from an indifferent app menu. Behind these virtual care clinics are frequently large corporations, like the American pharmaceutical giant, McKesson, the pharmacy chain, Rexall, and the ubiquitous grocery chain, Loblaws.

The Canadian Medical Association (CMA) is currently travelling across the country holding a series of town halls on how best to incorporate privatization into our health care system (currently a public-private mix). Debates on health care privatization have a long history with little resolution, but the rapid expansion of corporate investment into health care’s gaps doesn’t seem to be a priority in recent conversations, nor the role of government in supporting large corporations seeking a share of the health care pie.

Instead of engaging in the same decades-old debates, we should be critically examining what it means when health care is seen as an opportunity to maximize profits and shareholder returns. Does the privatization gold rush improve overall societal health or is this yet another symptom of our decaying system? The sooner our leadership addresses these questions, the sooner we can have meaningful conversations about health care privatization and what it means for all of us.

Dr. Michelle Cohen is a family physician in rural Ontario and an assistant professor in the Department of Family Medicine at Queen’s University.


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