Danielle Smith of the Wildrose Party has been quoted extensively talking about health care in the Edmonton Journal and Globe and Mail, among others. The Wildrose is running on a platform of creating a two-tiered system of health care in Canada. They claim that offering private health care creates more options, reduces wait times and protects and strengthens public health care. Each one of these points is false and not backed by evidence from the science and health research community. I'm going to attempt to separate myth from fact in the paragraphs below. I hope you'll read more.
Myth: Private care reduces wait times
Fact: Health professionals are in short supply in Canada. We need more nurses, doctors, technicians (MRI, CT, X-ray), anaesthesiologists, and others. When we create a parallel public-private health-care system we split these much needed health professionals into two different systems, creating more demand while the supply remains static. This creates a backlog in health care and lengthens wait times for everyone. Studies completed on parallel private systems have not shown a reduction in wait times for public health care. In the U.K., a parallel private health system has only extended wait times.
"This backs up Canadian evidence from the province of Manitoba where, until 1999, patients paid an additional facility fee or "tray fee" if they chose to have cataract surgery in a private facility (the surgery itself was still paid for by the provincial health plan). At the time the fee was in place, the Manitoba researchers found that patients whose surgeons worked only in public facilities could expect a median wait of 10 weeks in 1998/99; however, patients whose surgeons worked in both public and private facilities could expect a median wait of 26 weeks" (Canadian Health Services Research Foundation, 2005).
Myth: Two-tiered health care creates options
Fact: Two-tiered health care only creates options for the richest and healthiest among us. The private system is notorious for cherry-picking patients. The private system can make money off of healthy Canadians, but they cannot make money off patients who have chronic care needs. The private system will often refuse those patients services -- like you often hear of with private insurance companies who have qualifying tests that people must pass or they're denied coverage -- and then the public system is left with the most expensive and complicated patients which bankrupts the system -- which we're seeing happen in England to the National Health Service.
For healthy and wealthy Canadians, a two-tiered system does mean more options. However, many private facilities have been shown to offer lower quality and more dangerous care -- adding the profit motive to care means finding cuts somewhere. And yes, efficiencies can and need to be found in both the public and private systems, but, investors will always want bigger returns on their investments and in some cases the drive to make money has come at a cost to safety (see this Marketplace episode on private cleaning companies in hospitals).
Private care may offer you services faster, but it does so at a very high cost. Even in Alberta. Redford is offering to pay for private services with public money but only to a certain point -- the cost of the service in the public sector -- and then patients will need to pay out of their pocket.
A parallel private health system offers choice to the healthy and wealthy at a cost to public health care. The public system is the only one that offers the choice to receive care to all Canadians. But if you bankrupt the public system by allowing the private one to cherry-pick patients, then there is no choice for anyone (for more information on how this happens see the references to the NHS at the bottom of the blog).
Myth: Two-tiered health care protects and strengthens medicare
Fact: Medicare is protected and strengthened when governments invest in publicly delivered health care. The privatization of health-care delivery in Canada has shown to weaken health care. Parallel delivery systems (meaning for-profit and public) have drained health care resources by splitting human resources and directing investments outside of public health care.
To protect and strengthen universal health care in Canada we need provincial, territorial and federal governments to enforce and commit to the principles of the Canada Health Act: comprehensive, publicly administered, portable, accessible, and universal, and to the criteria of the Act: no user fees or extra-billing for medically necessary services. The federal government needs to work with the provinces and territories to implement evidence-based and innovative best practices -- that are happening in pockets and silos across the country in the public sector -- and extend those practices into every province and territory. We need to share best practices with one another and work together to strengthen the system.
Resources need to be spent on extending health care to cover areas that are much needed such as: pharmacare, continuing care, dental care, and mental health services. These areas would ensure that Canadians have a full continuum of care from cradle to grave -- which was the initial intention of medicare's founders.
The Quebec example
The notion of parallel public and private delivery systems is not new to Canada and several provinces have been expanding the scope of private services in health care. Canada's most extreme example of a private parallel system is found in Quebec. After the Quebec V. Chaoulli case in 2005 Quebec began privatizing some medically necessary services and offering what the Wildrose party is now proposing a two-tiered simultaneous public and private health care system. Quebec now has over 55 delisted services -- these are medically necessary services which are given a benchmark time in which they must be performed and completed. If these services cannot be completed within that benchmarked time then patients are eligible to seek private care, which is paid for with public dollars.
Some Quebec doctors are abusing the system by artificially inflating wait times and moving patients to their own private practice. When doctors are able to practise in both the public and private sector (as some Quebec doctors are) and receive higher remuneration through duplicate private health insurance, this has been show to encourage a higher service volume in private delivery to the detriment of public delivery. It has also shown to delay surgery in the public sector (to maintain long waitlists), and raises numerous ethical questions when doctors refer public patients to their private practice (see: Duplicate Private Health Care Insurance: Potential Implications for Quebec and Canada. Odette Madore. Economics Division, Parliament of Canada. 20 March 2006)
It seems like Alberta is proposing something similar, except that doctors won't be paid by the public purse for the additional expense of private care. Instead, the additional money will come from the pockets of the patients. This means that only those that can afford the additional expense will be able to jump the queue. Those in need -- who may live paycheque-to-paycheque -- will be forced to wait longer, and if they're unable to work, they'll have to make do with even less income.
Instead of splitting resources between the public and private sector which creates a two-tiered system and unjustly lengthens wait times, the Albertan government could be strengthening the public sector by investing resources there. Danielle Smith of the Wildrose Party has estimated that paying for a two-tiered system will cost $180 million a year for the province -- this figure doesn't include what it will cost Albertans out-of-pocket when they use the private system. Why not invest the $180 million a year in innovation in the public sector? Use that money to implement some of the evidence-based solutions that are already available and being implemented in provinces and territories across the country. $180 million will go further in the public system than the private and it will ensure that all Albertans have access to the medically necessary services they need.
Since the 2004 health care accord Canadians have witnessed some drastic reductions in wait times in benchmarked surgeries. This could go even further, if the Albertan government was willing to invest the resources needed instead of starving the public sector by withholding funds and splitting human resources. By investing in the public sector and using evidence-based innovations -- wait times will be reduced for all Albertans. It's a straightforward, sensible and kind solution.
Watch the 2014 Health Care Accord Townhall with Maude Barlow here (3 parts):
Why a private-parallel system lengthens wait times:
Canadian Health Services Research Foundation (CHSRF). Myth Busters: Myth Busted, March 2001; Busted Again! March 2005. Available here.
Read more about the problems of two-tiered health care from real-life examples:
Children's health services opening to for-profit interests.
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