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 consequences if there were to be more access to private health care in Canada, including greater income 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 case is Vancouver's Cambie Surgery Centre, which describes itself as the only free-standing private hospital in Canada. The centre's operators are fighting provincial regulations that ban private insurance for medically necessary services.

Cambie's legal 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.

Cambie and 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 was unconstitutional under the Quebec Charter of Rights because the public system had failed to guarantee patients access to services in a timely way. 

Some other provinces also allow private insurance for publicly covered services and let doctors work in both the public and private system.

'Society as a whole would be worse off'

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

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

More Canadians would face financial hardship or even — in extreme cases — "medical bankruptcy" from paying for private care, he writes.

Frank even suggests there could be deadly consequences. He says complications from privately funded surgeries often need to be dealt with in the public system because private facilities are generally less equipped to handle complex cases. 

"If such complications, arising from privately funded 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," Frank writes, 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," said Day, citing France and Germany as examples.

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

As for the claim the private system will siphon off the best-trained doctors, Day compares 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 says the government got involved in the case because "it's fundamentally 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 said Friday 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, but argues it shows care 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 case because many provisions of the B.C. legislation mirror those of the Canada Health Act, making this case of significant importance not only to British Columbians, but to all Canadians."

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