The CMA’s annual meeting began on Sunday and will continue until tomorrow. This year’s theme: transformation of the health care system. There’s no denying that our system needs to change -we can all agree on that. The question is, to what?
Imagine this. You are sitting in a gorgeous white and chocolate-colored leather arm chair. To your left is a fancy espresso machine. Beside you, a selection of gourmet snacks. Where are you?
If you guessed a café, you’re wrong. If you guessed a first-class lounge at an airport, guess again. Believe it or not, you are at the doctor’s office, waiting to get your nasty cough checked out. The clinic you are enjoying is in Québec and it is called “Avenir M.D.,” or “Future M.D.” in English.
Privatization of health care services is becoming increasingly popular across Canada, mainly for surgeries and specialized diagnostic tests. The difference with Québec is that privatization is hitting a new section of health care services: family medicine. While the number of private family physicians in Québec is still small, it is growing quite rapidly. Nearly 25 doctors leave the provincial health insurance plan each year, opting for less strenuous working conditions, where they will see less than half of the number of patients as they would in the public system. In 2007, 61 of Québec’s doctors turned private. In 2009, the number sits at 113.
There are various reasons why more doctors are choosing to opt out of the publicly funded health plan. It seems pretty clear that a major incentive is higher salaries. Without the provincial government controlling funding, physicians in private clinics can charge whatever they want. Private doctors often argue that working outside of the public system is preferable because it allows the privilege of spending more time with each patient. With a less hectic schedule, private physicians are less pressured to move quickly from patient to patient. While there is no denying that patients in the public system are sometimes made to feel rushed at their doctors’ appointments, there are ways to address this issue other than through privatization. For example, switching from fee-for-service remuneration to a capitation model, in which doctors are paid based on the number of clients they serve rather than on the number of services they provide, would encourage the type of patient-centered care that may attract some to private clinics.
How is this small shift to private family practice impacting Québecers? Well, it certainly isn’t helping to deal with the already existing challenge of finding a family doctor in the public system. It could also potentially lengthen wait times for admission to emergency rooms which have recently skyrocketed, with 17-hour waits not uncommon.
Luckily for us, this scenario isn’t currently possible in Ontario, since our provincial government prohibits doctors to work outside of the public Medicare system. But in Québec, family doctors can cater to the needs of those who are willing and able to pay their way to faster care. The problem is that permitting parallel private services neglects the health of the majority of the population, who will suffer from doctor shortages and two-tiered care. Access to health care should be distributed on a needs basis, such that patients with the greatest medical need are treated with priority. When family doctors choose to leave the Medicare system, they are making a statement that ability to pay should be the principal determinant of access to care.
A report by the Ontario Health Coalition revealed that there are 130 for-profit clinics across Canada, mainly for diagnostic scanning and specific types of surgery. Not only are they in violation of the Canada Health Act, but they are hurdles that stand in the way of reaching a fully equitable system where everyone has equal access to the same standard of care. Québec’s privatization is even more detrimental, because it is occurring in primary care. Not only is there two-tiered care for diagnostics, but there is now two-tiered care for everyday visits to the doctor. Privatized Health Care Won’t Deliver, a policy paper written by Dr. Michael Rachlis and commissioned by the Wellesley Institute, explains in detail why privatization is not an appropriate solution for Canada.
The privatization of family medicine in particular raised some new concerns. First, primary care has the greatest potential to focus on health prevention and promotion, which are crucial in keeping a population healthy. Second, in many provinces, including Ontario, family doctor shortages are currently more severe than shortages of specialists. So when family doctors leave the public Medicare system, the impact is even greater.
The CMA conference brings to the forefront the issues of our health care system. Should our future system be one that prioritizes patients based on their socioeconomic status? Or should it work for everyone, regardless of income level?