07) PRIVATE CLINICS ERODING PUBLIC HEALTH CARE

(The following article is from the October 16-31, 2008, issue of People's Voice, Canada's leading communist newspaper. Articles can be reprinted free if the source is credited. Subscription rates in Canada: $25/year, or $12 low income rate; for U.S. readers - $25 US per year; other overseas readers - $25 US or $35 CDN per year. Send to: People's Voice, c/o PV Business Manager, 133 Herkimer St., Unit 502, Hamilton, ON, L8P 2H3.)

A groundbreaking new report investigating 130 for-profit surgical, MRI/CT and "boutique" physician clinics across Canada presents evidence of 89 possible violations in five provinces of the Canada Health Act's requirement for equal access to health care and prohibition on extra-billing patients.

     Released by Health Coalitions in several provinces, the report details the for-profit health industry that has emerged over the last five years, and the first forays of U.S. private health companies into Canada.

     Report author, Natalie Mehra, Director of the Ontario Health Coalition, called upon the federal government to live up to its responsibility to protect Canadians from extra-billing and two-tier health care:

     "We found evidence that for-profit clinics are eroding the fairness and equality of Canada's health system that is supposed to provide access to necessary hospital and physician services based on need, not wealth," said Mehra. "A significant proportion of for-profit surgical and diagnostic clinics are billing provincial health plans and also charging extra fees to patients to maximize their revenues and profits.

     "The charges are unaffordable for all but the wealthiest Canadians. Clinics told us they charge $13,000 to $20,000 or more for knee surgery, $1,200 to $2,000 or more for cataract surgery, and hundreds to thousands of dollars for MRIs.

     "For-profit clinics are also taking specialists, health professionals and operating room nurses out of local public hospitals to serve less urgent patients, often for extra fees. Despite claims about reducing wait times, we found direct evidence that poaching staff out of local hospitals by for-profit clinics worsened shortages in local hospitals, forcing the hospitals to reduce MRI hours. We found evidence of staff poaching out of local hospitals by for-profit clinics in Nova Scotia, Quebec, British Columbia, Ontario and Manitoba.

     "Ironically, while some provinces are considering introducing for-profit clinics for the first time, we found that Alberta, Ontario and Manitoba - under governments of varying political stripes - all have rolled back their experiments with for-profit MRI/CT clinics or surgical clinics, opting instead to build capacity in the public non-profit health system where access is improved on an equitable basis. In Ontario and Manitoba, the for-profit cancer and cataract surgery clinics revealed direct evidence of higher costs per treatment than non-profit clinics. This should serve as a warning to provinces like Quebec, New Brunswick, Nova Scotia, Saskatchewan and British Columbia where more for-profit privatization of health care is being considered.

     "We found that the for-profit clinics overwhelmingly locate in large urban centres where there are more wealthy people to buy their health care procedures, raising concerns about worsening access in rural areas," she added.

     "Particularly regarding the physician clinics that charge thousands of dollars per patient per year, there should be grave concern that their low caseloads and their high costs imperil access to care for the majority of people. In cities like Montreal, where Statistics Canada reports patients have the worst shortage of family doctors in the country, there is a high incidence of `boutique' physician clinics selling executive health care for hundreds or thousands of dollars per year per patient. Yet the vast majority of people could not afford these services. This low volume high cost approach of `boutique' physician clinics is simply not sustainable and threatens health care access for many more people if it is allowed to spread."

     Mehra urged stronger pressure on federal party leaders to halt two-tier health care, and on provincial governments to ensure improved and equitable access to health care, based on medical need, not high incomes.

     The full report in English and a French summary are available at http://www.ontariohealthcoalition.ca or http://www.healthcoalition.ca.