Cracking down on private clinics means cracking down on patients in need
British Columbia Health Minister Adrian Dix’s recent announcement, which threatened large fines for doctors accepting private payment for treatments covered by Medicare (extra-billing), suggests a fundamental misunderstanding of the challenges faced by patients and the provincial health-care system more generally.
Not only will such action constrict a vital pressure-valve offered by private clinics, but it will move our ailing provincial health-care system even further away from more successful universal systems around the world. Worse, the announcement’s timing, which coincides with the Cambie Clinic’s fight in court for patients’ right to pay for treatment, suggests nasty hues of bullying by the provincial government.
It’s important to first understand that while the issue has been framed as a situation where doctors are forcibly charging extra-fees, many patients are willing and, indeed, desperate to pay these fees to receive the treatment they need. Why? Because the so-called “free” government-run system is failing to deliver timely access to medically care.
The Fraser Institute’s annual wait times survey reveals that the average wait time (between referral by a general practitioner to receipt of treatment) was 26.6 weeks in B.C. in 2017.
This wait time is longer than the national average, longer than what physicians consider medically reasonable, and the longest in the survey’s history spanning two decades. In fact, in 1993, when the survey calculated a national average for the first time, wait times in B.C. averaged 10.4 weeks—less than half the time patients can expect to wait today.
In some cases, the median wait for treatment be more than a year. In fact, the median wait in the province for orthopaedic surgery was 66.1 weeks and 64.7 weeks for neurosurgery.
B.C. patients can expect to wait 24 weeks just for an MRI scan—often vital to diagnose the severity of a patient’s condition in the first place (never mind actually receiving treatment). It’s no wonder that patients are willing to pay to receive treatment, even outside our borders. If anything, physicians should be applauded for delivering these services outside of hours funded by the single-payer government monopoly.
The real question should be why Minister Dix (pictured above, left) believes the government should intervene in these consensual agreements between physician and patient, without offering a meaningfully superior alternative.
To be fair, Minister Dix is partly responding to increased interference by the federal government. Acting on last year’s threat to more fully exercise the financial powers enshrined in the Canada Health Act, it seems Ottawa reduced transfer payments to the province last month due to reports of extra-billing in the province. Whether Minister Dix is simply bowing to pressure, or is only too happy to play along, is beside the point. The fact is that such penalties actually harm the government-run public system by reducing financial resources available for treatment, discourage private options from acting like a much-needed pressure valve, and may reintroduce more patients back into the public queue.
While B.C. Premier John Horgan and Minister Dix have also announced increased funding for certain procedures to help ease the pressure, these are only Band-Aid solutions. We’ve seen politicians use the “throw money at the problem” approach for years, and it just doesn’t work in the long-run. It’s time for a new playbook.
Many countries around the world that run more successful universal health-care systems, with shorter wait times for the same (and sometimes lower) cost. None of them follow Canada’s restrictive approach.
In fact, Australia, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland and the United Kingdom embrace the private sector as either a partner or alternative. Most of them routinely expect patients to share in the cost of treatment (with exemptions for vulnerable groups, and annual caps on expenses). And most generally allow physicians to work in both the public and private sector simultaneously.
None of these other countries outright forbid patients from paying for services using their own resources. While B.C.’s unnecessarily harsh ban on extra-billing doesn’t go quite as far yet, it reinforces the notion that the private sector—and those who deliver services to patients willing to pay—are part of the problem. They’re not. If anything, they’re part of the solution.