In January, Doug Ford announced the province would significantly expand the number and scope of procedures performed in for-profit surgical and diagnostic imaging clinics. The Ford government aims to add capacity in the health care system by redirecting money and resources from the public sector to the for-profit sector. This is yet another step in the Ford government’s continuing plan to privatize health care in Ontario.
The developments in Ontario revived discussions around private and public delivery of health care in BC. While public funding of private surgical procedures in Ontario is expanding, BC is not immune to this trend. The privatization of health care services in BC has expanded over the past two decades.
The claim is that adding capacity to the health care system by contracting out to private for-profit clinics can help resolve backlogs. However, that's not the case. A Canadian Institute for Health Information analysis in 2021 showed that waits for cataract surgery in provinces that contract to for-profit clinics were not that much better and that wait times for hip and knee replacement were substantially worse. In fact, wait times can be made worse by contracting out to for-profit clinics as those clinics pull health professionals from the public to the private system. In Saskatchewan, contracting to private surgical clinics helped to clear a backlog, but wait times eventually increased. All this is in addition to evidence that shows outsourcing of surgeries to for-profit clinics cost more than if they were performed in a public hospital and with worse outcomes.
For example, the BC Ministry of Health led an initiative to outsource surgeries to private surgical clinics to clear the backlog that was exacerbated by the pandemic. Yet, orthopedic surgeons claim that wait times are higher than they were before the pandemic.
The BC government has made strides to reinvest in the public health care system. They have expanded public diagnostic imaging and surgical capacity through the purchase of private MRI and surgical clinics. They have brought workers back into the BC public hospital system. These are positive steps! What sets BC apart from other provinces isn’t its hybrid approach to health care delivery. BC stands out amongst other provinces and territories because it leads other provinces in the amount of illegal extra-billing.
What is extra-billing
Extra-billing is a practice where health care providers charge patients either directly or through their private insurance for medically necessary procedures covered under BC’s Medical Service Plan. Although the practice is a violation of BC’s Medicare Protection Act, this has not stopped the practice in BC. In an attempt to curb extra-billing, the B.C. government re-introduced the Medicare Protection Amendment Act (MPAA) in 2018. The MPAA set out significant financial penalties for offenders who were extra-billing along with clarifying the scope of extra-billing. Yet, the province has been slow in using the enforcement mechanisms of the MPAA to curb unlawful extra-billing in private surgical clinics and has delayed enforcement of provisions of the MPAA that relate to extra-billing and private MRI/diagnostic facilities. It wasn’t until December 2022 that the Medical Services Commission filed an injunction against Telus Health for allegedly extra-billing its patients through its Life Plus program. The MSC filed a second similar injunction against Harrison Health. This activity to enforce the MPAA comes nearly four years after it went into effect.These injunctions are welcome legal developments to curb an unlawful practice but come almost four years after the MPAA went into force.
At the same time, some of the surgical centres that the government is contracting out to are receiving funding from the government while also allegedly extra-billing patients. For example, the government audited both False Creek Surgical Centre in Vancouver and Kamloops Surgical Centre. The government found both clinics to be extra-billing patients. The government hasn’t penalized either of the surgical clinics. Instead, both clinics have received public contracts from the government.
Extra-billing impacts us all
While it may seem that the only patients impacted by extra-billing are the ones who seek out surgical services at investor-owned for-profit clinics, a closer examination reveals that unchecked extra-billing has the potential to undermine the entire health care system.
The federal government provides health care funding to the provinces and territories through the Canadian Health Transfers. Over the years, the federal government has clawed back this funding to B.C. due to the province’s lack of enforcement around extra-billing. The rate of decline is on a dollar-for-dollar basis. In other words, the federal government withholds a dollar of federal health funding for every dollar an MSP-enrolled physician unlawfully charges its patients. This affects all patients of the health care system in BC.This decline is especially important at a time when the provinces, including B.C., are requesting more health care funding from the federal government.
Canadian Health Transfers & premiers meeting
On February 7, Premier David Eby, along with other territorial and provincial leaders met with Prime Minister Trudeau. The premiers are demanding that the federal government increase federal health care funding to the provinces. It's imperative that the premier invest Canadian Health Transfers into the public health systems instead of diverting that funding to non-health care costs or into the pockets of private investors. The increased funds could go a long way in providing much needed investments in expanding access to primary care, better care for seniors, and increased investment in the public health system.
By making meaningful investments in the public health system, we could see a number of improvements, including less reliance on private, for-profit clinics that often redirect resources away from the public health care system and are only accountable to their shareholders. Increased Canadian Health Transfers could also mean more capacity and resources so that the Medical Services Commission can enforce the MPAA to monitor and clamp down on extra-billing.
Despite the lack of extra-billing enforcement, the provincial government is making efforts to increase capacity in the public system. During the Throne Speech on February 6, 2023, Lieutenant Governor Janet Austin stated, “Some jurisdictions are pushing for more privatization, allowing the wealthiest to buy their way to the front of the line. Make no mistake, that doesn't fix the line. It would only lead to more costs and longer lines for the rest of us.” Premier Eby has indicated that his government will be looking to use public models to increase health care system capacity, rather than expanding the use of for-profit clinics. That is good news if Eby’s government follows through.
If it does, then B.C. can show the other provinces that it’s not the poster child for privatization. Rather, B.C. can be a leader in reinvesting into its public health care system by curbing unlawful billing, bringing for-profit clinics into the public system, bringing workers back into public hospitals, and accepting conditions for more federal health care funding to ensure that funding benefits the health of all those in need. This will mean holding the B.C. government accountable to make sure this reinvestment happens.