How much private influence can we have in Canada’s health care system before the dreaded ‘two-tier’ label becomes the more appropriate one?
In Ontario, the line has already started to blur, say health care advocates, who see both a public system operating chronically underfunded hospitals and a suite of hybrid “boutique” clinics opening up to serve the needs of those who want more services – and can pay for it.
“Private clinics have started to move in as provincial governments have closed down public, not-for-profit health care services,” said Natalie Mehra, Executive Director for the Ontario Health Coalition, to the Sault Online. “Patients don’t stop needing the services,” she said.
Mehra and her OHC colleagues were in Sault Ste. Marie recently, ahead of an upcoming provincial bi-election, to speak on the need to protect public health care, a cornerstone principle for Canada’s health care system they say is currently under threat. “Private sector clinics, in all sectors of health care, have been lobbying for billing patients. Their funding model is to maximize profits,” said Mehra.
The main arguments on both sides are well known. Private clinics say that they don’t represent a challenge to Canada’s publically funded system but an enhancement, augmenting Medicare with personalized services and shorter wait times for tests. Detractors, on the other hand, insist that opening the door to hybrid clinics infringes on the egalitarianism at the heart of the system.
A new report by Torstar and the Ryerson School of Journalism looked into Ontario’s growing boutique clinic phenomenon, where sleek urban clinics charge patients thousands of dollars per year for a range of services that promise to go above and beyond what OHIP can offer. Extra testing, personalized health and lifestyle assessments, MRI’s available upon request and blood screening and imaging assessments are all on offer for those willing to pay.
Allowing hybrid medical clinics undermines Medicare, says Dr. Danielle Martin, Toronto family physician and founding chair of Canadian Doctors for Medicare, to the Toronto Star. “… it contributes to an ethos that the public system is not delivering the highest quality . . . We need to push back against this myth that having extra testing is harmless. The potential for harm is very great,” says Martin.
The services offered by private clinics can themselves be harmful, too, says Toronto cardiologist Christopher Labos, who states that providing more testing — often more than is deemed medically necessary – may give people an extra sense of security, yet research has shown that because all medical procedures come with risks, however small, increasing the number of tests also increases the risk of harm.
“Maybe that CT scan isn’t dangerous, although it is exposing you to radiation that you don’t need, but any little abnormal finding is going to lead potentially to biopsies and more procedures,” says Labos. “And these biopsies and procedures carry risks. If you do enough unnecessary tests, eventually you will cause a complication from all the overtesting.”
Ontario Health Minister Eric Hoskins admitted that some of the boutique clinics have billing practices that exist in a “legal grey area” that the ministry is “monitoring very closely as we accumulate information so that we can fully assess the situation.”
“Any deviation from the values and integrity of our Medicare system are concerning, and we will continue working hard to uphold our high standards to build a health-care system we can be proud of for future generations,” Hoskins said.