Health minister weighs in on for-profit health-care clinics in Nova Scotia

The opening of a private, for-profit medical clinic in Halifax earlier this week has stirred discussion about the role of a two-tiered health system in Nova Scotia.

The Bluenose Health Clinic on Young Street charges patients a monthly subscription fee for access to a nurse practitioner and patients pay for individual treatments.

Health minister Michelle Thompson spoke to CBC Information Morning Nova Scotia host Portia Clark about the province's position on two-tiered health-care and what power the province has to oversee private clinics .

Their conversation has been edited for clarity and length.

What is your position on private, for-profit clinics like the Bluenose health-care centre?

We've been clear as a government that we are committed to a publicly funded health-care system.

I think it's really important that people know that. We follow the Canada Health Act and we know that there are times when private clinics do pop up in our province, but we are committed to improving and working within a publicly funded health-care system.

How many of these clinics are operating now in our province?

As a province we don't we don't regulate those.  We don't know how many there are.

As far as we know there are not many. We do keep our eyes open for for these and the federal government does as well because of the implications with the Canada Health Act. So I don't have an exact number for you in terms of how many clinics there are in delivering primary.

So there's no oversight from the health department over these for-profit clinics?

There's no provincial oversight. The clinicians that work in these private clinics are regulated by their professional bodies ... and are expected to work within their scope of practice and adhere to their code of ethics.

Our health-care columnist Mary Jane Hampton describes the conditions that allow these kinds of clinics as a loophole in the legislation. The Canada Health Act covers procedures that are medically necessary, but the only procedures that are medically necessary are things done by a doctor or done in hospital. Do you agree with that assessment?

I think the Canada Health Act is dated for sure.

It was developed in 1984 and if you think about how our health-care system has changed over those years, it really was a doctor-delivered service back in those days. And now we see team-based care, we see nurse practitioners, we see a variety of allied health-care professionals whose scope have expanded which is why we want team-based care.

Do you think the loophole should be closed?

I think that the federal legislation should certainly be updated.

We're at a significant time of transition in our Canadian health-care system looking at team-based care, how we access a variety of providers looking at digital opportunities.

I think that there is room for that legislation to be modernized and more currently reflect what's happening across the country.

Do you think it would be a helpful model to open these kinds of clinics in a not-for-profit scenario? In other words, have, perhaps, nurse practitioners operating a clinic, but not making money out of it and it would still be a public service?

We absolutely want to increase access to care. And team-based care is really what we hear consistently around best practices but also from our health-care professionals.

So we want a team-based environment where physicians and nurse practitioners, allied health-care professionals, family practice nurses work in concert together to support the needs of Nova Scotians.

Some folks will call it collaborative care, some folks will call it a health home,  so that individuals are attached [to a family practice], and have access, at a particular clinic where their needs are met. 

That's the goal. That's where we're moving as a province and that's what we'll continue to invest in and recruit to.

This clinic that just opened in Halifax, the Bluenose clinic, has hired two nurse practitioners, which means two nurse practitioners who won't be part of any public health-care teams. Does that concern you?

We know that our resources are finite and we're working very hard to create an environment that is very attractive to our health-care providers.

There are individuals who may choose to work in the private sector and [they're] certainly able to do that. But our goal is to make a health-care system that's ready, responsive and reliable not only to our patients but also to our health-care providers.

And so we continue to work with our associations and colleges to understand what our health-care workers are looking for, the environment that they want, and we're willing to invest in those teams and in those clinics that will improve access and improve attachment.

Private clinics rely on the health-care system that we all pay for and for the tests that they order, for example, out of those clinics. Don't those profit clinics basically operate at a cost to all of us?

It's very important if people are going to access private care that they understand how those practitioners intersect with the public system. It is really essential that before you enter into that therapeutic relationship that you know the scope of practice is suitable for the care that you require.

So that if it is outside of their scope of practice they are able to articulate a clear pathway for you into the public health-care system.

It's very important that people ask those questions before they receive care.

The premier has been very clear that we want to create that system where people can access care through the publicly paid for system and we will continue to do that.

The reason people are turning to the for-profit scenarios though, is because they can't get access to the public system in a timely way.

We've worked really hard over the last 18 months to look at the different access points.

So there is virtual care Nova Scotia, we've incorporated a pharmacy and nurse practitioner model of care.

In some communities we now have pharmacist primary care. In some communities we have after-hours clinics and mobile clinics.

So we've been working very hard to look at how we support access and also how we make investments that lead to attachments.

There is a lot of work to do. We knew that when we came in and we continue to make incremental improvement toward that.

I want to let Nova Scotians know that we are working very hard, the teams are working very hard, to create that ready, responsive and reliable system that they can access when they need it.

Even as we're talking about this, four doctors just announced in Halifax that they're getting out of family practice and 4,000 patients between them won't have their doctor anymore. What could have been done about that particular situation?

I know that the doctors and the Department of Health and medical affairs worked really hard to find a solution and unfortunately we weren't able to do that in this case.

I know that it's unsettling and it's frightening for people when they don't have a family practice.

We need to ensure that when we add resources into a team or into a clinic that it results in more access and more attachment. Dalhousie Family Medicine is a great example of that. That clinic felt that they were at capacity. We were able to work with them to add additional resources and optimize their practice, which resulted in over 3,000 people coming off of our need of family practice registry. 

We also need to make sure that when we support a clinic or we support a practice that it's something that we can equitably scale across the province. 

Unfortunately, in this case we weren't able to do that. But I want to acknowledge that those physicians have decided to contribute to our health-care system in a different way and we are grateful that they're staying in Nova Scotia.

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