Putting primary care out for corporate bid

In December, the Ministry of Health issued a “request for proposals” for 1.5 million virtual doctor or nurse practitioner visits in British Columbia, according to a report by CTV News. The large and extensive nature of this contract privileges large corporations like Telus Health, with a very short one-month period – much of it over the holidays – for providers to apply. Rather than investing in community-based primary health care capacity, the contract risks further corporatization of primary care.

Corporatizing primary care

As many struggle to access primary care, residents of BC have good reasons to fear the growing involvement of corporate providers. This skepticism was recently voiced by Premier David Eby himself while commenting on an eating disorders contract awarded to Telus by Island Health.

"There’s a huge amount of interest in the private sector in getting into health care,” Eby said. “They see opportunities to make money there. The challenge is that in our health-care system, those who support privatization of health care always fail to explain to my satisfaction how adding profit margin to the limited number of health workers we have somehow improves services for people.”

Yet corporate profits are increasingly a part of our primary care system. At our Sticking Up for Public Health Care Townhall, Dr. Lindsay Hedden exposed the rapid rise of large investor-owned companies like Telus Health, Walmart (Jack Nathan clinics), and Loblaw (Primacy Management), among other publicly traded corporations, which have been acquiring primary care clinics and virtual care platforms.

According to Dr. Hedden, the shift to corporate delivery in primary care has several major implications:

1. Profit-driven companies tend to push legal boundaries to extract profit from either extra patient charges or the public purse, as was the case with the Telus Health Life Plus Plan.
2. Contracted care requires burdensome layers of public monitoring and regulation to keep companies accountable.
3. Private companies are less transparent about public spending, making public accountability an issue.
4. Corporate providers tend to maximize profit by focusing on patient volume and overusing or upselling profitable services that have little clinical value.
5. Complex cases are often referred back to public providers. Especially in episodic virtual care, in-person assessments are referred to public clinics, emergency rooms, or community based family practices.

A foot in the door for corporate providers

Minister of Health Adrian Dix has defended “the need to expand short term solutions” to complement the government’s goals to recruit more long-term primary care providers. But these short-term service contracts are a strategic entry into formal relationships with government for corporate providers and are rarely temporary.

Evidence shows that companies are quickly becoming more entrenched in our primary health care system by securing contracts and making themselves indispensable. Once they have a foot in the door, Dr. Hedden worries that it is unlikely that governments will be able to put the toothpaste back in the tube.

Destabilizing the public sector workforce and padding profits

The problem with outsourcing – a form of privatization – is that contracted private providers compete for the same employees as the public system. As employees are recruited to work for corporations, there are fewer providers left for the public sector.

Several physicians who spoke on background to CTV News described the strategy as “one that corporatizes health-care and adds unnecessary bureaucracy while centralizing control with the Ministry of Health”. This system is a win for the contracted provider – likely a large corporation – who will secure a very large contract and become a permanent fixture in the health care system.

The contract will be awarded in April 2024, so there is time to call on the provincial government to scrap this contract in favour of one that expands not-for-profit primary care delivery like Community Health Centres.

Public solutions

Rather than risking to further entrench corporate interests in our primary care system, we need to invest in public solutions that expand access to primary care. This includes investing in primary health care infrastructure that would guarantee access to primary care based on geographical catchment areas, funding and expanding access to community health centres, and utilizing the full team of allied-health professionals.