Canada Needs to Crack Down on Private Services to Save Public Healthcare

Canadians pride themselves on their publicly funded healthcare system, so it stung when Donald Trump singled us out in a recent presidential debate for travelling south to the US to pay for medical procedures (even if medical tourism is a reality, at least for some people who live here).

Now, the Canadian Medical Association Journal (CMAJ) is calling on the Minister of Health to give more teeth to the existing law and to “punish violations” by levying fines, in order to stop privatization from sneaking into universal healthcare.

Canada is grappling with the fate of its publicly funded system. In September, orthopedic surgeon and former Canadian Medical Association president Brian Day launched a legal challenge against the B.C. government to lift a ban on private insurance, which he says violates patients’ rights by forcing them to endure long waiting times for medical services.

If Day is successful, the CMAJ warns, it could be the beginning of the end for our cherished single-payer system.

Editors at the CMAJ acknowledge the current system has problems, like its notoriously long wait times—one woman in Quebec waited nine years for a medical appointment. A consequence of this, they say, is the emergence of a two-tiered system that allows well-off people to opt for private treatment abroad, or here in Canada, which has seen private clinics springing up alongside the rise of extra billing for certain procedures.

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“Doctors cannot, by law, charge you more for something that is covered under the public system,” deputy editor at the CMAJ and co-author of the editorial, Matthew Stanbrook, told me by phone. “They can charge you for things that aren’t covered. You can charge for some types of plastic surgery. But for anything that’s covered, you’re not supposed to charge."

Stanbrook explained that some physicians are billing for out-of-pocket fees while provincial governments look the other way. He says the provinces aren’t singling out doctors who violate the act, mainly because the reporting system is voluntary.

“It’s to their advantage [not] to do so…they certainly have no incentive to get less money from the federal government," said Stanbrook.

The government has a big enough stick with which to discipline offenders, he said, but the will to wield it is lacking. A good start would be for the Minister of Health to punish violations to the full extent of the law. Stanbrook would like to see that happen uniformly.

The CMAJ is also pushing for the provinces and territories to spend smarter and to innovate more. There’s no shortage of proven, cost-effective ways they can choose to tackle wait times—centralized intake, virtual care, and physician-led approaches such as the Saskatchewan Surgical Initiative—and they aren’t dependent on a private system.

As a new health accord—the agreement between the federal and provincial governments to make sure healthcare is meeting the current needs—is being hammered out, the CMAJ wants the government to go to bat for equitable, universal Canadian healthcare. If it fails, you could be facing a hefty bill for medical services in the future.

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