Ontario Premier Doug Ford’s proposal to use private health centres to alleviate long wait lists has run into opposition from many quarters. It may seem counterintuitive, but Mr. Ford’s plan will actually alleviate the shortages of doctors and nurses.
It was B.C.’s NDP government of the early 1990s that adopted the bizarre proposition that it was better to have fewer doctors and nurses. They theorized that treating patients increases costs. Medical school admissions were reduced and barriers were put in place to make it harder for immigrant doctors to practice. Nursing schools were also closed. A B.C. Royal Commission on health care recommended that immigrant physicians be barred from practising in the province.
The current shortage of family doctors was created by former governments but, when it comes to surgeons, many today are underemployed, including young orthopedic surgeons (the longest waits in the country are in orthopedics) who are denied hospital privileges and operating room time. Twenty-three of Cambie Surgery Centre’s 78 visiting surgeons reported they would not be practising in Canada if it were not for the additional O.R. time we offer them.
Canada has an above-average number of nurses per capita among OECD countries. Many graduating nurses consider employment in the U.S. A single Detroit district employs more than 1,000 Ontario-based nurses, many of whom commute across the border. They exit the Canadian work force because of the toxic environment in our public hospitals. Mr. Ford’s plan will certainly cause many of them to return based on better working conditions at private facilities. This will add to the Canadian work force – the opposite of what opponents claim.
In the 1990s, governments across Canada closed hospitals and cut hospital beds, causing our world ranking of hospital beds per capita to fall from 8th to 30th today. Roy Romanow, when he was the NDP premier of Saskatchewan, oversaw the closing of 52 hospitals. He was rewarded by being made chair of the 2002 Royal Commission on Health.
Private for-profit facilities providing public surgeries offer significant economic advantages for governments. The centres are built at no cost to taxpayers and the construction phase creates jobs and economic activity. If these facilities are successful, unlike public hospitals, the centres generate tax revenue for all three levels of government. If they fail, the government does not suffer any losses. Those advantages are currently enjoyed by other provinces that contract out surgeries at costs significantly below that of large hospitals. In Alberta, the government says it expects cost savings of around 20 per cent on surgeries at private clinics.
Mr. Ford’s plan will also improve quality of care. In large public hospitals, patients face increased risks of encountering “superbug” bacteria and preventable deaths owing to complications. While the patient populations aren’t exactly the same, in my experience, I’ve observed that there are lower risks to patients in smaller, private clinics. Based on the annual numbers of surgeries in Ontario, Mr. Ford’s plan should save hundreds of lives every year.
Private facilities must place patients first. Canada’s system of block annual funding of public hospitals limits access. Patients consume the hospital’s taxpayer-funded revenue. In other OECD countries, patients bring in funding rather than consume the facility’s revenue. That same incentive applies when public surgeries are contracted-out to private clinics since the funding then follows the patient.
In Canada, governments take the strange position that they control a citizen’s body and their health through their state-operated monopolies. Canada makes access to private health insurance for basic health services unlawful (exceptions include injured workers, federal employees, non-residents, and prisoners). Research shows that Canada spends more on health care as a percentage of GDP than many other advanced economies, yet ranks near the bottom of the pile when it comes to equity in health care. Statistics Canada data show that low-income groups suffer from the worst access and outcomes.
Private insurance and private facilities will introduce much needed accountability and competition and provide Canadians with a comparison to the status quo. A private option will not mean the wealthy get better care than the poor. We can simply emulate other countries and fund or subsidize insurance premiums for lower income groups. Competition will pressure governments to improve the public system and if that occurs, private options may become less necessary.
Brian Day is an orthopaedic surgeon, president of the Cambie Surgery Centre and past president of the Canadian Medical Association. Published originally in the Globe and Mail, January 23, 2023.
Related – Euro-Canada Health Consumer Index (ECHCI). The ECHCI is an international comparison of healthcare system performance in 34 countries.