Canadian doctors warn against private medicine as a cure for the system’s ills

With approximately 6.5 million Canadians now without a personal doctor and interminable wait times for certain medical procedures nearly the norm, private medicine is increasingly being touted as a solution to these and other problems in Canada’s public health care system.

Private medicine comes in many forms. Ontario’s Progressive Conservative government plans to increase public funding for cataract surgery and MRI scans in private clinics and outsource hip and knee replacement surgeries.

In Quebec, doctors have increasingly left the public medical system altogether to open private clinics where patients pay thousands of dollars a year to see a family doctor. Elsewhere, clinics are exploiting a loophole that prohibits payment for essential medical services by using nurse practitioners instead of doctors.

Canadians who cannot tolerate the wait times have long been flying to other countries for self-paid surgeries.

Many hospitals in the country are dealing with the nursing shortage, which has become widespread during the pandemic, by hiring temporary nursing staff from commercial agencies.

But now there is a design set of recommendations of the Canadian Medical Association says it is time for governments to stop paying for services long covered by the public health system and warns that private provision of health care can lead to poorer quality and higher costs.

“Anytime you have a system in crisis, there’s going to be change,” Dr. Joss Reimer, a Winnipeg physician who is president of the medical association, told me this week. “So I think it’s a critical moment for us to hear the voices of Canadians about what they want that change to be, because there are holes in the system. There’s no question that our public system is suffering.”

The medical association formulated its recommendations after consulting 10,000 healthcare providers and patients through town halls, surveys and focus groups, among other things.

Canada’s system has always been a mix of private and public delivery. Physicians are not government employees themselves, but bill governments for their services while covering the costs of their offices and employees. Many services, particularly laboratory testing, have long been provided by for-profit companies that, again, charge governments for their services.

A major problem with involving the private sector, according to Dr. Reimer, is that it inevitably leads to a greater shortage of doctors and nurses.

“When the solutions that are being put forward are to have private services fill the gaps, it’s still the same providers that end up in those private services,” Dr. Reimer said, noting that the Winnipeg hospital where she works had closed a number of units due to a nursing shortage, “but we have nurses who are moving into nursing agencies on a regular basis.”

Although health care is a provincial responsibility, the large transfer payments from the federal government to the provinces to help them cover health care costs are subject to conditions set out in the Canadian Health Act. It prohibits doctors from charging for “medically necessary services” while also charging provinces. But only Ontario currently prohibits doctors from opting out of the public system.

About 780 doctors have left the public system in Quebec, a province with a long waiting list for family doctors. By comparison, in the rest of the country, only 14 have left the system.

Dr Reimer said the association had also looked at all available research into how patients fare when treated through public services compared with those treated by private providers. The overall trend, she said, was clear.

“Private services, whether they’re publicly or privately funded, tended to have higher costs and worse outcomes than the same service that was publicly provided,” she said. “When we looked at all the literature, that was certainly the trend that made us cautious about investing money in privately provided services.”

She said the trend did not mean that all privately provided medical services were inferior or more expensive. But she said governments should proceed with caution and analyse any shift to private provision from both a financial and medical perspective.

Private medical services are of course a growing business in Canada. Last month, a pension fund in Ontario sold LifeLabs, one of the few major laboratory testing companies, to a major testing company in the United States for CAD 1.35 billion.

In a report published in July, a report from Ontario College of Pharmaciststhe province’s professional licensing association warned that its members were facing increasing pressure from companies that own dispensaries to increase their business volume and profits.

That pressure, the report states, affected ‘the quality of care they want to provide to their patients’.

It added that the situation led to ‘less emphasis on patient interests and more on profit’.

Dr. Reimer acknowledged that the medical association’s recommendations to governments would conflict with corporate lobbying that “wants to get their foot in the door of the health care system.”

She added: “I can’t say how they will weigh these two different voices. But I do know that it is critical that doctors across the country, and all the patients that we talk to and represent, have a voice.”

This section was compiled by Vjosa Isai, a Toronto-based reporter and researcher.

• Canadian environmental activist David Suzuki dismissed a risky idea from scientist David Keith — cooling the Earth by using a pollutant to block sunlight — as “arrogant and simplistic.”

• Elaine Glusac, a columnist for The Times’ Frugal Traveler, explores how incentive programs reward tourists for good behavior. In British Columbia, Tourism Squamish offers food vouchers to travelers in exchange for bags of trash picked up along trails and at campgrounds.

• The Times’ Food staff tested coffee brands from celebrities including Tom Hanks, Emma Chamberlain and Toronto-born singer and songwriter The Weeknd and came up with mixed reviews.

• A report from the US Department of the Interior reveals for the first time how many indigenous children are dying in government boarding schools.

• Canadian musician Alanis Morissette spoke to The Times about the moments in her life that give her strength and perspective, 25 years after the release of her second global album.

• A exhibition featuring the work of the Filipino-American artist Pacita Abad arrives at the Art Gallery of Ontario this fall. “You’ll be sorry you missed it,” wrote Andrew Russeth, an art critic for The Times, in a review of Ms. Abad’s first retrospective at MoMA PS1 in New York.

• Canadian director Robert Carsen, best known for his opera productions, took his talents to Salzburg, Austria, where his version of “Jedermann,” an annual festival piece, “stands head and shoulders above other recent productions of the work,” writes The Times theater critic A. J. Goldmann.

• And now, on to the Olympics. Here’s a selection of stories featuring Canadian athletes that you may have missed this week:

  ‘We are all experiencing the Olympic Games via TikTok now’The times)

  Who is leading the medal count?The times)

  Children at the Olympics: ‘It’s a bit crazy, to be honest’ (The times)

  The spying during the Olympics is just the latest example of how Canada Soccer is failing its players (The Athletics)

  Canadian teen star Summer McIntosh sets Olympic record, wins gold in 200m butterfly (The Athletics)

Born in Windsor, Ontario, educated in Toronto, Ian Austen lives in Ottawa and has written about Canada for The New York Times for two decades. Follow him on Bluesky on @ianausten.bsky.social.

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