We believe health care should be there for everyone regardless of our capacity to pay. Our shared public health system is the most effective way to deliver quality care to all.
Yet our public system is threatened by investor owned private clinics and large corporations who are seeking to make a profit out of providing physical and virtual care to patients. The right for Canadians to access public health care without financial duress is at risk. With too little national public attention, serious challenges to single-tier public health care in Canada are coming to a head especially in the landmark Cambie trial. We need private interests out of health care so that we can focus on advocating for improvements to our shared public health system.
This case is the most serious threat that the public health care system has ever faced. It seeks to erase from our laws the fundamental concept of care based on need, not ability to pay.
Cambie Surgeries CEO Brian Day launched this constitutional challenge to public health care in BC in 2009 after he learned his private for-profit surgical clinics were going to be audited by the BC Government. The audit was triggered by dozens of patients who complained that they had been illegally over-billed at Cambie Surgeries clinics. An audit later revealed that Day’s clinics had overcharged patients by almost half a million dollars in just 30 days. Instead of paying back the money his clinics illegally over-billed, Brian Day marshalled a group of private, for-profit clinics and a few of his patients to file a constitutional challenge.
The corporate plaintiffs are seeking to make health care more profitable by striking down the key protections in BC's Medicare Protection Act (Sections 14, 17, and 18). These provisions maintain private and public health care as two separate systems with no financial connection, and limit preferential access to essential health care services for financial gain.
The decisions in the case could fundamentally shift how health care is delivered in Canada to a US-style health care system. To enable us to administer our publicly funded health care system on our own terms, the Canadian government negotiated important protections within our Free Trade deals. However, these exemptions have been grandfathered in and are based on the public, not-for-profit character of Canada's health care system. If the Cambie case is successful and the nature of our system is transformed, these protections would no longer apply and could never be restored. This would allow the full force of US private insurance firms to enter the Canadian market, bringing with them the profit-first ethic that has severely compromised care in the U.S.
The case will almost certainly advance to the Supreme Court of Canada. The outcome will impact all provinces and territories because the rules the plaintiffs seek to strike down are central to the Canada Health Act and every provincial health care insurance plan.
Private clinics have taken over services formerly provided on a non-profit basis in public hospitals, they have bolstered their owners’ incomes and profits by charging extra user-fees to patients amounting to hundreds or even thousands of dollars for medical care. For patients, costs have risen and user fees have proliferated. And as clinics have gained an expanding foothold, they have grown more aggressive. In some cases they are flagrantly charging patients for services for which they have already paid in their taxes, in violation of public medicare laws. In some cases they are double- dipping -- billing individual patients and public health plans for the same procedures. Dangerously, private clinics have institutionalized the practice of co-mingling medically needed services with medically unnecessary tests and procedures to sidestep Canadian laws that prohibit extra user fees for patients.
Corporations are moving aggressively into virtual primary care including through apps that operate as virtual walk-in-clinics undermining continuity of care. Patients and physicians are turning to these models due to unmet needs in the current system; however, these models will result in negative outcomes on health outcomes, privacy, and societal inequality. Some of the issues identified with virtual care are:
- Inequitable infrastructure & delivery - the pushing of virtual care services leads to issues of inequity as some populations have trouble accessing virtual care especially if that care is not grounded in existing care provider relationships. In addition, the draining of physicians from the public system into private virtual care platforms creates even more demand for the majority of patients.
- Poor clinical outcomes - virtual care not grounded in existing or new long-term care provider relationships lead to worse outcomes for patients as there is less follow-up and less attention paid to the social determinants of health for patients. For-profit private providers do not share information with long-term or existing care providers leaving gaps in patient knowledge and follow-up
- Monetization of patient data - for-profit operators are entering the virtual care space seeing profit to be made out of not only providing services to patients but also to monetize patient data. These for-profit operators are not accountable to the public on how patient data is stored or collected.