Marc Lee: More privatization is not the solution for BC health care

Leading up to the 2024 election, the BC Conservatives are promising major health care reforms, in particular a greater role for private health care. More choice and competition, they claim, will unleash the power of private-sector innovation” and reduce wait times. Theres good reason to be skeptical of such claims. If anything, evidence and “common sense” show that BC needs to reverse creeping privatization already in the system to improve access, quality and affordability of health care for all.  

Health care is a large and complex sector in BC with $34.5 billion per year in public expenditures and $14.8 billion in private expenditures in 2023. Public and private shares represent 70% and 30% of total health expenditures, respectively, and 8.2% and 3.7% of GDP. 

Coverage for hospitals and for physician services remain the core elements of Canada’s public health care system, underpinned by the principle that access to necessary medical care is based on need and not an individuals ability to pay,” as written in BCs Medicare Protection Act. Over the decades, public health care coverage has expanded to include other services, such as home care, long-term care, pharmaceutical drugs and other services.

Outside of the public system, many employers provide private health insurance with coverage (to varying degrees) for prescription drugs, vision and dental care, and other supplementary health services. Those without private insurance must pay out-of-pocket or go without those services. The private insurance sector also leads to duplication of administrative functions, coordination of care challenges (if a family is covered through two different plans, for example) and incentives for private insurance companies to deny claims to bolster their bottom line. 

To accommodate a growing and aging population, public health care spending needs to grow annually by about 5% in order to maintain the same level of health care services. The Conservative Party platform alludes to reducing the share of health care expenditures relative to GDP, which would imply absolute reductions in public health care services. This contrasts with other parts of their platform that calls for more doctors and nurses, and out-of-province care for diagnostics and medical procedures if waiting lists in BC are deemed to be too long, both of which will require more public dollars. 

In this context, claims that better public results can be achieved at less cost by adding private care are largely wishful thinking.

For example, a vision of private clinics or private surgical companies coming to the rescue of public health care implicitly assumes that a host of doctors, nurses and other professionals are sitting on the sidelines. In reality, the number of health care professionals is limited.  Allowing for more private health care only diverts limited resources to the most affluent, with the inevitable result that care and access will be worse for low and middle-income households. 

This contracting out can undermine care in order to boost profits. A 2023 report by the BC SeniorsAdvocate notes that more than two-thirds of publicly funded long-term care spaces in BC are contracted out to both non-profit (33%) and for-profit (35%) entities. Despite their contractual obligations to health authority funders, the report found that for-profit operators failed to deliver half a million care hours and non-profit care homes spent 24% more per resident on direct care. 

Commit to innovative and proven public solutions 

The good news is that there are many public solutions that have been proven to address the challenges facing health care systems in other provinces and in other countries. The BC Health Coalition has outlined 6 solutions that evidence shows will have a real impact on people receiving the health care they need, when they need it, and where they can readily access it.

One of those priority solutions is the need to improve access and quality of seniors’ care. With more than one million people in BC aged 65 and over in 2024 (and the number of seniors will dramatically increase over the next decade), the health care crisis will get worse if we do not invest in public solutions. Already, the Ministry of Health estimates that some 15% of long-term care patients could be receiving home care, and our public hospitals are backed up with seniors who cannot get into long-term care homes. Supporting seniors at home by eliminating the co-payment will allow more low-and middle-income seniors to stay in their homes as they age.  

This election, it’s important that voters take a critical look at what all political parties are proposing to heal the issues facing our health care system. Rather than being misled by the magic promises of privatization, we need political parties to commit to investing in the expansion of the pubic health care system and to ending contracting out to private corporations.

Marc Lee is a Senior Economist at the Canadian Centre for Policy Alternatives BC Office.