The Cambie Surgery Centre argues doctors should be able to work in both public and private sectors. Photo: CC, Vic.
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B.C. court case could set a precedent for expanding private health care

On Sept. 6, the Cambie Surgery Centre argued before the British Columbia Supreme Court that doctors should be allowed to work in both private and public health-care systems.

They also argued against the ban on “extra billing” for privately provided health services—that is “to be able to take the government or social insurance money and bill whatever they wish on top of it.”

B.C. Health Minister Jane Philpott says “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.”

This is especially true if the case should go up to the Supreme Court of Canada and become a nationwide precedent.

Would it be a bad thing if Canadian doctors could work in both private and public healthcare systems? No, not if it’s done right.

In the Great White North, most people’s gut reaction to the idea of health care reform is to not mess with the storied system that Tommy Douglas gave us. However, this argument fails to take into account the fact that a two-tier system already exists in Canada.

For instance, we already pay for medical services like physiotherapy, eye, and dental care, and many prescription medications out-of-pocket. With this in mind, privatized health care could lead to more competition among health-care service providers to provide better and more accessible services at a more affordable rate. After all, private healthcare will have to be better than public healthcare to survive.

It could also be more competitive in terms of professional talent, offering the opportunity of higher salaries to doctors and nurses, thereby discouraging them from pursuing opportunities in other countries, especially the US.

In 2000, a Statistics Canada report found that 25 per cent of newly graduated doctors left for the United States. A follow up in 2015 found that 10 per cent of health professionals go south of the border.

There are also concerns that the Affordable Care Act—also known as Obamacare—will cause more health professionals to go stateside to fill the growing demand.

Some fear that concentrating health-care resources on those who can afford them will leave those who can’t with longer wait times.

Conversely, proponents of a two-tier health-care system argue that it will free up access to the public health-care system. The answer, as is often the case, lies somewhere in the middle.

The United States is often used as a cautionary tale when it comes to private healthcare. But people forget that countries like England, Germany, France, Sweden, and the Netherlands also have two-tier or privatized health-care systems, and they don’t have the bad reputation the U.S. does.

One example is St. Goran’s hospital in Sweden, which is run by Capio, a private company. The hospital styles itself as being more efficient while maintaining quality, and so far numbers have backed it up.

As of 2013, the average hospital stay in Sweden was 4.5 days, compared with 5.2 days in France and 7.5 days in Germany, with Swedish citizens living slightly longer than those neighbours, who have a lower level of privatization in healthcare.

Because of this, there has to be a reason to deny doctors the right to collect extra billing in private practice. As long as they do so without prejudice to public healthcare, I fail to see why not.