Death, bankruptcy and longer wait times: Ottawa warned about more private health care

Justin Trudeau's government is gearing up for its first big battle against for-profit health care and it's armed with some dire warnings.

They come from an expert report commissioned by the federal government for a court case in British Columbia in which the government sought and received intervener status.

The report, which was obtained by CBC News, lists many potential negative consequencesif there were to be more access to private health care in Canada, includinggreaterincome inequality, more people in dire financial straits, and even doctors encouraging longer wait times in the public system in order to nudge patients into the private system.

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At the centre of the caseis Vancouver'sCambieSurgery Centre,which describes itself as the only free-standing private hospital in Canada. The centre's operatorsare fighting provincial regulationsthat ban privateinsurance for medically necessary services.

Cambie'slegal challenge is scheduled to begin Sept. 6 in B.C. Supreme Court. It pits the facility and several patient plaintiffs against the Medical Services Commission of B.C., the provincial Ministry of Health and the B.C. attorney general.

Cambieand its supporters, including the Canadian Constitution Foundation,also argue doctors should be permitted to work in both private and public health-care systems.

They have some legal precedent on their side. In 2005, Canada's Supreme Court ruled 4-3 that Quebec's ban on private care wasunconstitutional under the Quebec Charter of Rights because the public system had failed to guarantee patients access to services in a timely way.

Some otherprovinces also allow private insurance for publicly covered servicesand let doctors work in both the public and private system.

'Society as a wholewould be worse off'

But John Frank, a Canadianphysician who is now chairman of public health research and policy at the University of Edinburgh, argues in hisreport that more private health care "would be expected to adversely affect Canadian society as a whole."

He cites research that suggests public resources, including highlytrainednurses and doctors, would be siphoned off by the private system.

More Canadians would facefinancial hardship or even in extreme cases "medical bankruptcy"from payingfor private care, he writes.

Frank even suggests there could bedeadly consequences. He says complications from privatelyfunded surgeries often need to bedealt with in the public system because private facilities are generally less equipped to handle complex cases.

"If such complications, arising from privatelyfunded care, are not promptly referred to an appropriately equipped and staffed care facility, the patient is likely to experience death or long-term disability, potentially leading to reduced earnings and financial hardship."

Overall,"in my expert opinion," Frankwrites, the change would reduce fairness and efficiency and"society as a whole would be worse off."

Cambie Clinic disagrees

"It's the exact opposite," said Dr. Brian Day, medical director at the Cambie Surgery Centre,when asked about the report's claims.

Day, who is past president of the Canadian Medical Association,points to international criteria that rank Canada's health-care system poorly compared to those of other industrialized nations.

The Commonwealth Fund, for example, put out a report in 2014 that ranked Canada 10th out of 11 countries, ahead of only the United States. It looked at measures including efficiency, access to care and equity.

"All of the countries ranked ahead of us have a private hybrid system operating along a public system," saidDay, citingFrance and Germany as examples.

He argues more private care would decrease wait lists in the public system.

As for the claim the private systemwill siphon off the best-trained doctors, Daycompares it to public and private schools in Canada, which he says co-exist well.

He expects the Cambie case will eventually end up before the Supreme Court of Canada and argues it's a waste of tax dollars for the federal government to intervene now, particularly given that some provinces already allow private insurance for medically necessary procedures.

"To me it's a very simple question and that is, if the government promises health care, fails to deliver it, do they have the right under the Constitution to stop you or your loved ones from extricating yourself from the pain and suffering that then ensues? That's how simple this is."

'This is a concern'

Health Minister Jane Philpott saysthe government got involved in the case because"it'sfundamentally important to the health-care system in the entire country, not just in British Columbia, that we make sure that medically necessary services are universally insured and there are no barriers to access to those services."

When asked whether there's a role for some private care, Philpott pointed out that some services, like physiotherapy, are already offered privately. The crucial difference, she said, is that those services aren't defined as "medically necessary" by the Canada Health Act.

"Anything like a user fee is a barrier to people being able to receive medically necessary care and there is excellent evidence that is not the appropriate health policy,"Philpott saidFriday at the Liberal caucus retreat in Saguenay, Que.

"It goes completely against the principles of the Canada Health Act, which included accessibility and universality and we're committed to upholding those."

As for comparisons to other countries, Philpott has cited that very same Commonwealth Fund study as Day, butargues it showscare in Canada could be co-ordinated more effectively.

Health Canada also released a statement explaining the government's interest in the Cambie case.

"The Government of Canada has involved itself in this casebecause many provisions of the B.C. legislation mirror those of theCanada Health Act, making this case of significant importance not only to British Columbians, but to all Canadians."

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