Canadians share a deeply held belief that access to needed health care services should be based on need and not the ability to pay. Rooted in our health care system are the values of equity and fairness but these values lie in opposition to the goals of the free market. There is a profit to be made in health care and therefore the protection of public health care will require strong and vigilant allies. We believe in protecting and improving our public health care system; a system that puts patients before profits.
Canada’s federal government sets the national direction for our health care, providing both funding and national standards to ensure quality of care for all Canadians. We need our federal government to enforce the Canada Health Act and keep health care public and accessible to all.
Canada does not have enough medical staff or resources to operate a two-tiered (public and private) health care system. Two-tiered and private health care systems remove needed health care providers from the public system and make them accessible only to those who can afford to pay for their services. This results in longer wait times in the public system and front of the line access to the richest one per cent.
Health care in Canada falls under the responsibility of the federal, territorial and provincial governments. The provinces and territories are responsible for delivering care while the federal government, in addition to delivering care to some communities, is also responsible for ensuring the provinces and territories are abiding by the Canada Health Act (CHA) meaning health care must be: publicly administered, universal, portable, comprehensive, accessible and delivered without user fees or extra billing. However, in the past ten years very little monitoring of the Act has occurred and this had led to gross violations of the Act where patients have been illegally billed or paid to jumped the queue ahead of others.
Public versus private health care in Canada
The current health care system in Canada is 70 per cent public, 30 per cent private. This is behind most European countries which are 80 per cent public. Canada’s private health care remains mostly in services not delivered by a physician or performed outside a hospital such as: dental care, vision services, medications, mental health, and home and long term care.
“Some have described it as a perversion of Canadian values that they cannot use their money to purchase faster treatment from a private provider for their loved ones. I believe it is a far greater perversion of Canadian values to accept a system where money, rather than need, determines who gets access to care.”
—Roy Romanow, from the final report of the Royal Commission on the Future of Health Care (2002)
The CHC is calling for:
- The federal government to enforce the Canada Health Act by telling provinces and territories that they must report annually on the state of public health care within their borders.
- When a province or territory acts in violation of the Canada Health Act, the federal government must withhold Canada Health Transfer funding dollar for dollar.
- Opposition to the development of a parallel private for-profit health care delivery system.
- The federal government must revoke the establishment license it has given to a for-profit plasma collection company. Canadian Blood Services must open more non-remunerated donor plasma clinics in Canada so people everywhere can donate (there are currently only 7 plasma collection centres in the country).
- Join and/or donate to the Canadian Health Coalition or your local provincial/territorial health coalition for updates on health care privatization happening in your community.
- Share your experiences with health care through our on-line story booth, over social media, in a an email or phone call to us, or write a letter to your local newspaper. Were you or a family member treated well by our public system? Where are investments needed to improve the system?
The issue in detail
Across Canada procedures formally considered “medically necessary” like physiotherapy, MRIs and CT scans are being taken out of public hospitals and run privately. Two-tiered services- with one tier for public patients and a second tier for private ones- result in longer wait times for the vast majority of patients.
In every country in the world, the bulk of money going to the provision of health care comes from governments. When the privateers talk about a tier of private health care, they aren’t talking about setting up efficient, competitive health care markets similar to the selling of real estate or automobiles. What they want is for the billions of dollars in public funds to be redirected to their private health care business. And, they want to direct and control access to health care. This is how investor profits are made.
Private, for-profit clinics are focused on making money for their shareholders. In order to accomplish this, patients must be given lots of treatment (necessary or otherwise) and few complications can arise. This has led to private clinics only accepting the healthiest and wealthiest patients, often refusing services to the elderly or those with chronic conditions. And if you get sick or complications arise, patients have been quickly referred to the public health care system so the private clinics don’t lose money.
Those who can afford private, for-profit treatment may not be getting better care. In Canada, for-profit MRI and CT clinics have been found to have higher non-medically necessary usage rates and a lower quality image. In the US, private for-profit hospitals have been found to hire less skilled staff and have higher mortality rates than not-for-profit hospitals.
There are gross violations of the Canada Health Act in every province and territory, for example the extra-billing of Ontario cataract surgery patients who have been billed hundreds to over a thousand dollars in fees they didn’t have to pay, and the creation of private MRI and CT scans in Saskatchewan that will allow people to jump the queue.
In 2015, Quebec’s National Assembly legalised extra-billing by passing Bill 20. In concrete terms, it means that it is now common in the province to pay for medically necessary services such as over $500 for anesthesia when having a colonoscopy or $80 for eye drops during the treatment of macular degeneration.
Private clinics are springing up across the country. Without any enforcement of the Canada Health Act by the federal government, provinces and territories are allowing the proliferation of illegal and unethical medical bills. In British Columbia this has culminated into a BC Supreme Court Challenge by Dr. Brian Day where he is demanding the right to charge his patients as much as the market will bear.
In many cases governments are encouraging privatization by partnering with private companies to build and operate hospitals and clinics. These public-private partnerships (P3s) are enticing to governments because in the short-term they keep the full cost of building new facilities out of the government’s budget, however in the long-run they cost the public more money to essentially rent our medical building from a private company. P3s are privately owned, privately managed, publicly paid for. In multiple studies P3s have been shown to be more expensive, often inefficient and sometimes do not meet the requirements for which they were built. The Brampton hospital is one such example where the new hospital was built for almost double the original cost yet with 25 per cent fewer bed than promised.
Despite the all the evidence that private health care is inefficient and sometimes dangerous, new areas of privatization are now being opened up. The Saskatchewan government announced in 2016 that they would be the first province to allow a private, for-profit company to remunerate plasma donors. Plasma is a straw coloured portion of blood that is used in anti-clotting drugs for hemophiliacs. Health Canada has given an establishment license to a for-profit company to collect and reimburse this blood product and then to sell it possibly on the international market. This poses a serious risk to the safety and security of our blood supply but the ability of a private company to make a profit has been put before the security of Canada’s blood.
There is an enormous profit to be made and is being made in health care. Slowly our public health care system is being eroded away. Together with people and politicians from across the country we must protect our public health care system and defend it from the forces of privatization and greed.
When a province/territory fails to deliver health care in accordance with the Canada Health Act, the federal government must withhold money from the Canada Health Transfer. In the case of user fees, the federal government is supposed to withhold dollar for dollar the amount patients were charged. A solution to the continuing privatization of our health care system is for the federal government to enforce the Canada Health Act.
The Canadian Health Coalition has shown support of the 2016 Réseau FADOQ’s application to the federal court of Canada for a motion of mandamus. This motion is to force the federal government to take measures to stop the extra-billing of Quebec patients.
Further reading and tools for advocates
Private Clinics Report (Ontario Health Coalition in collaboration with the Canadian Health Coalition and other provincial health coalitions, June 2017)
Defending Donor Plasma Collection (Canadian Health Coalition, March 2017)
Eroding Public Medicare: Lessons and Consequences of For-Profit Health Care Across Canada (Ontario Health Coalition, 2008)
Eroding Public Medicare: Updated on For-Profit Healthcare in BC (BC Health Coalition, 2010)
Delivery Matters: The high costs of for-profit health services in Alberta (Parkland Institute, 2012)