Privatizing Canadian medicine

Reality creeping in

Since the first private MRI clinics opened their doors in Canada 10 years ago, there has been a national explosion of private health facilities with little policing by the federal or provincial governments, a report says.

Across Canada, there are 42 for-profit magnetic resonance imaging (MRI) and computed tomography (CT) clinics, 72 private surgical hospitals (excluding cosmetic surgery facilities) and 16 "boutique" physician clinics, the Ontario Health Coalition says in a report, entitled Eroding Public Medicare: Lessons and Consequences for For-Profit Health Care Across Canada, being released today.

Inside these clinics, the health coalition charges they found evidence to suspect 89 possible violations of the Canada Health Act in five provinces, including Ontario. Those violations include extra-billing patients for medically necessary services or selling queue-jumping services for a fee of thousands of dollars that let patients quickly access family doctors and specialists. "The contention that for-profit health care can exist along with a public system is not true," said Natalie Mehra, the report's author and director of the coalition. "It is a take-away from the public health-care system."

The deep cuts to Canada's health sector in the mid-1990s set the stage for a privatized system, she said. While the first for-profit MRI clinics opened 10 years ago, in the last five years private surgical and boutique clinics have opened. American health delivery systems are vying for a share of the market. The Cleveland Clinic, a large not-for-profit system in the United States, has a campus on Bay St. "There is a much more aggressive campaign by for-profit clinic owners to move into new territories and expand their operations," Mehra said. Federal and provincial governments have not been fast enough to respond to the changing market, she said. "We need to build the public pressure to make them do that," said Mehra. Every part of the country has been the target of for-profit clinics, except for Prince Edward Island, the Northwest Territories, Yukon and Nunavut, the report found.

The health coalition also noticed that wait times appear higher in areas with the most privatization as health-care workers stretch their time between hospital and private clinic. For instance, Montreal is one of the hardest spots to get a family doctor, yet has quite a few private "boutique" clinics selling two-tier care for wealthy executives and companies, the report notes. The vast majority of people can't afford to pay the private clinics' prices so they wait longer to see a doctor. "For-profit clinics siphon out scarce specialists' time and (schedule) medically unnecessary procedures," Mehra said.

Queue-jumpers who can afford to pay at private clinics do so, and that means people in the public system wait longer, she added. In Ontario and Manitoba, Mehra said, they found local hospitals have reduced MRI hours because technologists have gone to for-profit clinics.

Doris Grinspun, executive director of the Registered Nurses' Association of Ontario, said the federal government has simply "turned a blind eye" and not enforced the Canada Health Act. "If you close your eyes and don't enforce the act, you allow this to happen," she said. Even more of a concern is the Conservative party – clearly ahead in the election race – has yet to release its platform, said Grinspun. "A party that doesn't release a platform and gets elected has a blank cheque to go ahead with whatever they please." She said a clear promise needs to be exacted out of Liberal Leader Stéphane Dion that he will uphold and enforce the act after this election. "Governments have fallen down on it. The Harper government definitely has, but the Liberals did too. This trend needs to be reversed. They need to catch up to the reality that the for-profit clinics are moving into this country and we need to get ahead of them."

Dr. Michael Rachlis, a Toronto-based health policy analyst, says all of this private activity has flown "under the radar" for years without proper government oversight. "With the Conservatives in power, they have no interest whatsoever in moving on this file," he said. "Even in Ontario the provincial government isn't very interested in trying to look and see what happens."

However, there are two points of light – Canadians are devoted to their public health system and the Ontario Wait Times Strategy has driven wait times down in certain areas, such as cataract and cancer surgery and joint replacements. "Almost no one in Canada has private health insurance or goes south for care," he said. "In downtown Toronto, you can phone one number and get a cataract assessment or a hip and knee assessment within a week and get your surgery usually within a month. It's quite clear if we put our minds to it, we can fix these problems."

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Ambulance officers call for capsicum spray for violent patients

What depths Australia's socialized medicine system has fallen to!

PARAMEDICS want capsicum spray to protect themselves from violent patients, who are forced to wait for hours outside emergency departments. Ambulance union state organiser Jason Dutton said paramedics were increasingly at risk from angry and aggressive patients left waiting for hours outside crowded hospital emergency departments - a practice known as ramping. A patient assaulted an ambulance officer outside the Cairns Base Hospital's emergency department late last month.

"Paramedics are absolutely sick and tired of being used as punching bags," Mr Dutton said. "They need to be equipped appropriately. I'm not calling for ambulance officers to be allowed to carry guns, but capsicum spray could be incorporated into the training of paramedics and very clear guidelines could be used to assist them. "We're looking at arming paramedics with an appropriate tool so that when they are confronted ... they can look after themselves."

Mr Dutton, from the Liquor, Hospitality and Miscellaneous Union, which represents ambulance officers, said that paramedics sometimes found themselves in situations where they feared for their safety. But unlike police, ambulance officers were not issued with handcuffs, batons, guns and capsicum spray to protect themselves. "Paramedics are expected to treat people - who will often lash out violently at whoever is closest to hand - with no self-defence at all," Mr Dutton said. "We need to give our paramedics adequate protection from violent members of the public."

Mr Dutton said paramedics in some overseas countries were equipped with flak jackets or body armour.

A spokeswoman for Emergency Services Minister Neil Roberts said supplying paramedics with capsicum spray came under the Weapons Exemptions Act, which was a matter for the Police Minister, Judy Spence.

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