“Private” and “Healthcare” Why We Should Be Using These Words Together
It is well understood in Canadian politics that using the words “private” and “healthcare” in the same sentence is political suicide. While the outright privatization of our healthcare system will likely never happen, it is a fact that the private sector already plays a significant role in the delivery of healthcare in Canada. In fact, over 30 percent of the healthcare system’s expenditures are private – not public. Some would argue that the Canadian healthcare system was already in a state of turmoil before the pandemic – today there is no debate – the system is in crisis. We can no longer afford to fall back on tired discussions and debates. It is time to have an honest conversation about the role that the private sector can play to meet some of the 21st-century challenges that we are facing. We need to look to the private sector to support some of the system’s primary challenges, namely medical procedure wait times, backlogs and labour shortages. With no intention to abandon public healthcare, Canadians need to acknowledge the role that the private sector currently plays, as well as the role it can and should play going forward.
The Canada Health Act: Where does the private sector fit?
The word “private” holds two different meanings in the healthcare system. When we say the private sector can play a role, we mean private businesses can support the public system with resources, all while upholding the Canada Health Act. These private expenditures in our public system are essential for its survival. We run into trouble with the Canada Health Act when we talk about private billing. Private billing would require significant changes to our system that a majority of Canadians will likely never support. In fact, the B.C. Court of Appeal just dismissed an appeal by Dr. Brian Day, challenging legislation that prevents patients from accessing private care when wait times in the public system are too long. However, allowing the private sector to get more involved by providing more products and services to the public system is a solution that will solve some system problems within the boundaries of the Canada Health Act.
Today, hospitals outsource dozens of services to private companies that can provide products and perform services faster, cheaper and more effectively than the public sector. For example, private businesses research, create, design and manufacture medical technology, devices and pharmaceuticals to be sold to the public sector. Businesses also provide maintenance, janitorial, laundry, audit, legal, architectural and purchasing services, to name a few. Each of these products and services is delivered by the private sector within the public system. Public hospitals could not operate without private sector involvement.
Private sector expenditures in 2014 were $60.3 billion in Canada, much higher than most other developed countries. Private sector expenditures in Canada actually exceeded the total public and private healthcare expenditures in both Sweden ($55.6B) and Austria ($49.3B). Even though Canada’s private sector spends tens of billions annually on the healthcare system, Canadians remain vehemently against “private healthcare”. The stigma surrounding private participation in the public healthcare system is a misunderstanding of the key players currently keeping our system afloat.
A public healthcare system in crisis
Canada’s healthcare system was surely tested during the pandemic and is facing a new crisis post-COVID-19. During the pandemic, non-essential tests, procedures and surgeries were all postponed to make room for acute COVID-19 patients. These delays have resulted in a backlog of hundreds of thousands, if not millions, of medical procedures in Canada. According to the Ontario Medical Association, it will take years to catch up on the backlog of medical procedures in Ontario alone, even with MRIs and CTs operating at 115% capacity, as mandated by the Ministry of Health. Without clearing the diagnostic backlog, hospitals cannot clear surgical backlogs that rely on diagnostics.
On top of medical procedure backlogs, hospitals across the country are facing labour and staffing shortages, primarily as a result of staff burnout. The Ontario Hospital Association found that the total vacancy rate for full- and part-time permanent positions was more than 12 percent for registered nurses and more than 10 percent for registered practical nurses, as of March 1. Staffing shortages are also causing hospitals to close their Emergency Rooms, which is further adding to backlogs and wait times. With hospitals operating beyond their maximum capacities despite labour shortages, it’s clear that something needs to change.
We need to have an honest conversation…
The Ministry of Health and Hospital executives are aware that they need innovative solutions to solve the system’s current challenges. They should be looking to the private sector for solutions to reduce the backlog of medical procedures and to support hospital staff. In many cases, the involvement of the private sector in specific areas of the public system could in fact promote access and equity. The private sector can add financing, resource capacity, management expertise, innovation, and institutional learning. In terms of Ontario’s current challenges, the private sector could provide human resources capacity, as well as expertise and innovation to increase efficiencies, improve staff conditions and improve patient outcomes.
All of this can be done without jeopardizing the Canada Health Act but it requires an honest public conversation about the role of the private sector in our public system. If we want to fix our broken system, Canadians are going to have to get more comfortable with using the words “private” and “healthcare” in the same sentence.