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“These investigations into extra-billing show how easily the idea that you have no right to health care if you can’t pay for it can find its way into our health care system.” — Larry Brown, NUPGE President
Ottawa (19 June 2017) — Last week new evidence was released showing the growth in for-profit health care makes it harder for Canadians to get the medical treatment they need.
Both the Ontario Health Coalition and the Globe and Mail investigated extra billing by doctors in private, for-profit clinics. The investigations included information from patients who had been extra billed. Both reported that extra billing by doctors in for-profit clinics is widespread,and that it is causing financial hardship for many patients.
“These investigations into extra billing show how easily the idea that you have no right to health care if you can’t pay for it can find its way into our health care system,” said Larry Brown, President of the National Union of Public and General Employees (NUPGE).
Patients given the impression paying user fees was the only option
Many patients interviewed by the Ontario Health Coalition and the Globe and Mail believed that unless they were willing to pay user fees, it would be difficult to get treatment.
Among the comments patients made to the Ontario Health Coalition about what would happen if they didn’t pay user fees: there was “the implication was that the operation would not be performed” and that they would “not be given the best care.” The Globe and Mail reported that one patient found that, even though her operation took place in a public hospital, “paying for a quicker consultation [with her surgeon at a private, for-profit clinic] allowed her to jump the queue, ahead of those still waiting to see him.”
Many patients can’t afford fees
Many of the patients surveyed by the Ontario Health Coalition were charged fees they couldn’t afford. Patients reported having to cut back on what they spent on groceries or falling behind with other costs. It seems common sense that when people are recovering from surgery they should be eating properly. But the cost of private, for-profit health care means that eating properly is beyond the means of many patients who were extra billed.
Extra-billing violates Canada Health Act
It’s against the Canada Health Act for doctors who operate under provincial medicare systems to bill patients for procedures covered by provincial health care insurance plans. But private clinics are counting on patients either not being aware of the law or being too frightened to report violations. A number of the patients who were interviewed spoke about their fear that if they complained about user fees they would be unable to get treatment.
Ethical issues unavoidable with for-profit health care
Two ethical issues seem to go hand in hand with private, for profit health care.
The Ontario Health Coalition report states that, “Medical ethics are being violated as physicians in some clinics have become modern-day snake-oil salesmen in a bid to sell medically unnecessary add-ons at exorbitant prices.”
The Globe and Mail found doctors were referring patients to clinics in which they have a financial interest.
But that’s just the tip of the iceberg. When extra billing is permitted, doctors who own for-profit private clinics have an incentive to do what they can to undermine the public system. For them, longer waiting lists for public health care mean more patients willing to pay the higher costs of private health care.
Solution to waiting lists is fixing the public system
The most effective solution to long wait times for medical treatment is to fix the public system. Health coalitions across Canada have identified ways to use the resources in the public system more effectively. An example is the proposal from the BC Health Coalition to make better use of existing operating rooms. The same cannot be said for those profiting from private, for-profit health care.
“In all these years of advocating to save and improve services in our public hospitals, the private clinic owners that are justifying their extra-billing of patients by complaining about access to operating room time have been nowhere in sight,” said Natalie Mehra, executive director of the Ontario Health Coalition.
Governments must also be willing to ensure our health care system is properly funded.
“Proponents of private care like to claim we can’t afford to adequately fund the public system. What these investigations show is that it’s the user fees charged by for-profit clinics that Canadians can’t afford,” said Brown.