If you listen to the Canadian medical establishment, the kind of modest expansion of privately delivered public health care the Ontario government favours is a real walk on the wild side.
The Canadian Medical Association (CMA) has just put out a series of recommendations on “managing Canada’s public-private health care balance.” That’s apparently a euphemism for opposing private-sector solutions to health-care deficiencies.
Sure, 6.5 million Canadians don’t have a family doctor, nearly one-third of them in Ontario. Yes, there are unacceptably long wait times for surgeries and other vital services. The CMA concedes those points, but remains stubbornly suspicious of anyone trying to make a buck by fixing the problems. It’s almost as if the doctors’ group doesn’t realize its own members’ clinics are privately owned and profit-making.
One of the big ideas in the CMA policy paper is that if provinces can’t meet clinical guidelines for timely care, patients should be entitled to fully paid care in another province or country. OK, but the likelihood of finding care in another province is slim. They are all swamped. In effect, the CMA is saying it’s all right to send people to the U.S., where they would almost certainly get care from a private clinic, but it’s not acceptable to have such clinics here.
The CMA paper specifically wants to ban clinics that are charging fees for services by the Ontario Health Insurance Plan (OHIP), as some nurse practitioners are doing in Ontario. It is also highly skeptical of adding privately owned surgical clinics to help carry the load. Anything to do with a big corporation really worries them.
It’s an attitude that is not only out of step with what’s happening in Ontario, it ignores the fact that most advanced western countries have parallel public and private health-care systems. Even the fact that Ontario’s private-sector service expansion is covered by OHIP is not enough to satisfy the CMA.
Fortunately for Ontarians, the Doug Ford government is not as hidebound as the CMA is. The government likes to call its incremental increase in private sector involvement “bold.” That’s an oversell, but at least the government is creeping in the right direction.
After good results from new privately owned surgical clinics in Ottawa and Toronto, the government announced an expansion of the plan earlier this year. The Ford government has also increased the role of pharmacists, allowing them to treat 19 common ailments. Wednesday, it began consultation on a plan to let them diagnose and treat even more.
The Ford government has not been as enthusiastic when it comes to clinics led by nurse practitioners, who have advanced primary-care training. The government likes the idea when it approves the clinics and pays the nurses salaries, but not when entrepreneurial nurses band together to open a clinic and charge patients for the service.
Ontario Health Minister Sylvia Jones has asked the federal government to close a loophole in the Canada Health Act that does not explicitly ban such charges. So far, the feds have done nothing and neither has Ontario. The government has not received complaints from patients who choose to pay nurse practitioners rather than have no service at all. Presumably, they are among the up to 2.3 million Ontarians who don’t have a family doctor.
With such a shortage of primary care, one would think the government would welcome these fee-paying clinics and legitimize them by paying the nurses’ salaries, like it does in the other 32 nurse-practitioner clinics in the province.
The fact that it hasn’t illustrates an important limitation in the Ford government’s enthusiasm for private-sector help. It is willing to let the private sector provide more service, but only in ways and amounts that are dictated by the government. That’s driven partly by budget concerns, but also by the perceived need to control everything in our health-care rationing system.
Imagine if nurse practitioners were allowed to start clinics anywhere they wanted. Instead of government-approved clinics serving 100,000 people, there could potentially be far more. For comparison, the government doesn’t restrict the number of dentists, and there is no shortage of them.
The government likes to boast that 90 per cent of Ontarians have access to a primary-care provider, the best rate in the country. Put another way, that means about 1.5-million Ontarians don’t have a primary care connection. That’s lower than the estimate from some doctors’ groups, but it’s still a big problem.
A lot of people are paying health tax and income tax but not receiving basic service for their money. If the management of health care were contracted out to the private sector, God forbid, and people weren’t getting the service they were paying for, any government would find that unacceptable. Why is it better when government itself is shortchanging patients?
National Post
Randall Denley is an Ottawa journalist.
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