No evidence that for-profit health care results in better outcomes
By Monika Dutt and Rachel Tutte
Vancouver Sun, May 1, 2014
We are just four short months away from an unprecedented legal challenge to Canadian public health care that will put the fundamental Canadian principle of care based on need, not ability to pay, on trial.
The legal case is being driven by Dr. Brian Day, owner of the Vancouver-based for-profit Cambie Surgery Centre, infamous for unlawfully billing patients for health care services.
Dr. Day hopes to strike down the rules that prevent a U.S.-style system in Canada, where some people get to pay privately to jump the queue. His claim is that B.C.’s Medicare rules violate the Canadian Charter of Rights and Freedoms.
It is hard to overstate the significance of this challenge. If Dr. Day wins, the public system that Canadians rely on — and overwhelmingly support — will be dismantled across the country. We will be left with a system that looks very much like that of the United States — physicians will be permitted to charge patients any amount they like for services, and the rich elite will get care faster than the rest of us.
Evidence shows that the kind of system Dr. Day is seeking via the courts would result in longer wait times and poorer health outcomes for Canadians.
An abundance of evidence shows that for-profit hospitals reduce access to care for everyone but the wealthy elite. Studies in Canada, Europe, and the UK show that patients who can’t pay, and whose doctors work in both public and private systems, have the longest waits. Australian research shows that private for-profit clinics drain the limited supply of doctors and other health professionals from the rest of the health care system, lengthening waiting times for all but those who can afford expensive private insurance.
This bears emphasizing: A second, for-profit tier does not relieve pressure on the public system; instead, evidence shows wait times actually increase.
Similarly, there is no evidence that private for-profit care results in better outcomes — not anywhere in the world.
There is no doubt we are in need of improvements to our system. Those improvements need to reflect the Canadian values of equity and cost-effectiveness. We need to scale up evidence-based innovations that have been proven to reduce wait times and improve health outcomes. Across Canada, there are dozens of innovative projects improving access, quality, and cost-effectiveness while protecting equitable access to care. For example, the Alberta Bone and Joint Institute reduced wait times from 11 months to nine weeks for hip and knee surgery.
Dr. Day’s true motives are clear. A provincial audit of Day’s Cambie Surgery Centre and the associated Specialist Referral Clinic found that patients were unlawfully extra-billed $491,654 in just 30 days. In one case, a Cambie patient was billed $7,215.00 for services that would only have cost $1,288.04 in the B.C. health care system. Auditors also found over $66,000 in overlapping claims — evidence that suggests double dipping for the same services.
Charging patients nearly six times the actual cost of a procedure is not about human rights, and it’s not about system improvement. It’s about profit.
For the good of all Canadians, let’s hope this dangerous legal challenge is struck down and we can get on with the work of improving a system that cares for all of us.
Dr. Monika Dutt, chair of Canadian Doctors for Medicare, is a Medical Officer of Health, Cape Breton District and Family Physician. Rachel Tutte is co-chair of the BC Health Coalition and a physiotherapist.