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Health Law Blog

It’s Time to Look at Health Care Through a Different Lens and Embrace Private Clinics

March 9, 2020

As we await the verdict in a B.C. Supreme Court case where Dr. Brian Day argued the private sector has a role to play in our public health-care system, it is time all Canadians start to look at universal care differently.

The most salient indication that the current structure is not working is the one to three-year wait time for medically necessary operations across Canada. To cope with often debilitating pain while in the queue, many Canadians are forced to rely on addictive opioids.

Improving this model doesn’t have to be an all-or-nothing proposition. Patients and surgeons need to look at health care through a different lens and realize the system that started with Tommy Douglas, the “Father of Medicare,” has to evolve and change, to keep up with the needs of Canada’s growing population.

Dr. Day’s Cambie Surgery Centre in Vancouver -- which has been carrying out orthopedic surgeries since 1996 for patients who pay directly for the service -- has proven very effective in taking the stress off one part of an already overloaded public system.

Before Cambie, people suffering musculoskeletal issues had only two choices: wait in line for years for care in a public hospital, or cross the border to be treated quickly at a U.S. facility, but at a very high cost.

Dr. Day and his associates offered a middle ground, with more than 55,000 patients coming through Cambie’s doors for surgery since it opened. Every one of those cases made more space in the public system for those most in need.

Another advantage of Cambie is that it opens up opportunities for young surgeons who previously could not find placements in public hospitals. This lack of opportunity has been exacerbated in recent years, as hospitals no longer force surgeons to retire, believing it is discriminatory to do that on the basis of age alone.

Dr. Day saw there were patients who desperately needed surgery, while at the same time, young, talented surgeons were unable to practise their craft, so Cambie solved both issues at once, at no cost to the taxpayer.

Every Canadian should be able to get first-class medical care on the public purse. If a private facility such as Cambie allows people to get out of the public queue, then everyone behind them is treated sooner.

Since private-sector options are available that don’t harm anyone and will not compromise the public system, it is time the medical community and the public opened their minds to these new possibilities.

The first solution would be to allow qualified doctors to open accredited facilities to perform invasive surgeries for specific medically necessary conditions -- for those willing to pay the cost -- as Cambie did with orthopedic work in B.C.

Another solution is for public hospitals to outsource certain operations to private centres, reimbursing them an agreed-upon amount for each case. The patient would pay nothing in this scenario, as the money would come from the government’s global health care budget already in place to fund medically necessary operations.

This type of public/private partnership has already proven successful in Ontario, as shown by the Shouldice Hernia Centre in Markham and the Kensington Eye Institute in Toronto. With five specialized operating suites, Shouldice is the only licenced hospital in the world dedicated to repairing hernias, while 50 ophthalmic surgeons treat cataracts, glaucoma and perform retina surgery at the Kensington facility.

The success of these facilities proves it is time has come to move beyond the fallacy that our current public health care system is sacrosanct. Canadians have grown tired of having loved ones waiting years for medically necessary surgery. As well, these delays lessen the chance of a full recovery. People with spinal stenosis, for example may suffer irreparable nerve damage if forced to wait for treatment.

The sad reality is that no system that purports to cover everyone, from cradle to grave, can possibly afford the price tag, so waitlists are inevitable. To shorten those lines, Canada must move to some sort of hybrid health-care system, with private facilities complementing the work of the public system.

Canadians should not be misled by fear mongers who claim this will lead to an unfair two-tier system, or that the best doctors will only work in the private sector. There will be limited job opportunities in these private facilities, and all MDs have to work a certain number of hours in regular hospitals to maintain their privileges in the public system.

Finally, keep in mind that private clinics are not just for the wealthy, as middle-class Canadians will also be using them after they weigh the cost of finding money for surgery versus the toll of enduring years of discomfort.

While I hope Dr. Day is successful in his court challenge, it may not matter, since any verdict is sure to be appealed, with this matter inevitably ending up before the Supreme Court of Canada, which is going to take another five years while things just get worse in the public system.  

For the sake of Canadians who now are on years’-long waiting list for needed surgery, we can only hope that the courts realize that private-sector involvement can truly benefit and enhance the public medicare system that Canadians want to be proud of.

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