Private, For-Profit Clinics
“If you believe good health care is a right of all Canadians, then you cannot allow private businesses to disrupt the solidarity of your health system or to influence the cost or quality of your health services.”
- Arnold S. Relman, MD, Professor Emeritus at Harvard Medical School & Emeritus Editor-in-Chief of the New England Journal of Medicine
By the Numbers
| $7.2 Billion The increased cost every year to Canadians if Canada moved to a for-profit hospital system, according to a report in the Canadian Medical Association Journal. |
$21,780 The cost of hip replacement surgery in a for-profit private surgical clinic in Alberta. The cost for the same surgery in a non-profit hospital: $10,000. |
50% The increase in private health care spending in British Columbia between 2000 and 2005. The increase in public health care spending was less than 30%. |
250% The increase in costs of an hour in the operating room in private surgical clinics over the last ten years. |
0 Improvement in waitlists for cancer care a year after Ontario’s Sunnybrook Hospital opened a private cancer treatment centre at a cost of $4 million to the taxpayer. It was eventually closed. |
2,200 Number of deaths every year that would occur if Canada switched to privately-owned for-profit hospitals. |
The privatization guarantee: Pay more, Get less.
Since the early 1990s, a new industry of for-profit health care clinics and services has grown up across Canada. Today, for-profit MRI/CT clinics, surgical hospitals and boutique physicians clinics are offering medically-necessary services outside the public health care system in almost every region in the country. Under the guise of improving access to health care, these for-profit clinics are aggressively promoting their private services and threatening our universal system and equal access to quality care.
Pay More:
For-profit clinics charge a wide range of prices across the country, but they are all out-of-reach for most Canadians needing care. In Quebec, where there are the most for-profit MRI/CT clinics, the prices run from $600-$1,350 per scan. The median income in the province is roughly $24,000.
Get Less:
Private clinics don’t like patients who have complex or urgent needs. By choosing to do only the simplest - and highest revenue - procedures, the private clinics “cream skim” off the lucrative procedures and leave the highrisk, high-cost patients to the public system.
Pay More:
Ontario pays $474 to non-profit hospitals for cataract surgery. Private pay-for-surgery clinics allow patients who are able to pay up to $1,200 per eye for refractive lens to jump the queue, and the private clinic also charges the public system for the procedure.
Get Less:
Private clinic locate in high-population urban areas where there are bigger markets of wealthier clients. Rural and smaller communities lose access to badly needed services when private urban clinics “poach” scarce nurses, doctors, radiologists and other health professionals.
Pay More:
“Boutique” physicians clinics promote exclusive access and elite health care services to the wealthy. In BC, the Copeman clinic charges $3,900 for an “Elite” program in the first year, $2,900 a year after that. These clinics maximize their profits by billing the public system.
Get Less:
Private clinics promise to reduce wait times and improve access in the public system. But these clinics take scarce specialists, nurses and health professionals from public facilities to care for fewer, wealthier patients, while leaving the public system with fewer resources, longer waits and high-risk, high-need patients.
Background
Canadians treasure their public health care system and the access it provides to medically-necessary quality care for all, regardless of ability to pay. That care is being threatened by the erosion of public services and the rise of for-profit diagnostic, surgical and medical clinics that increase costs to the public system and to patients, reduce access, and do nothing about wait times. When the federal government began cutting health care transfers to provinces in the 1990s, provinces made changes that affected the delivery of health care services. The first for-profit clinics opened in 1993, and while there is no monitoring of these clinics, estimates put the number of clinics today at:
- 42 for-profit MRI/CT clinics
- 72 for-profit surgical clinics
- 16 boutique physicians clinics
These numbers don’t include cosmetic surgery clinics and other facilities offering medically-unnecessary services. Most of the MR/CT clinics have opened in the last ten years, with most of the surgical clinics and boutique physician clinics opening the last 5 years.
Increased cost to the public system
Private clinics do not reduce costs to the public system; in fact, costs increase where private clinics exist. Many of the surgical clinics, particularly the private surgical clinics, find loopholes in the Canada Health Act - or violate the act - to charge for medically-necessary procedures. Some will mix medically-necessary surgery such as cataract removal with optional costs such as refractive lens, billing the patient for the lens and the public system for the surgery.
“Facility fees” allow clinics to charge up to $5,000 in addition to the amount they billed the public system. Out of 42 private for-profit MRI/CT clinics across the country, 41 illegally charge patients for medically necessary scans.
Costs at private facilities are much higher than in public facilities. Knee replacement surgery costs about $8,000 in the public system; the private surgical facilities charge up to $18,000 for the same surgery.
Reduces access to health care
For-profit clinics for those who can afford to pay don’t help the rest of us get better access to health care. In fact, because private facilities poach scarce health professionals like physicians, nurses and technologists, the public system must struggle with fewer resources.
For-profit facilities locate in wealthier urban areas, making it even harder for those who live in rural and small communities or poor areas to get the health care they need.
“Cream skimming” or taking only the healthiest, highestprofit patients means that for-profit clinics leave the highcost, high-need patients to the public system. The result is a public health system with fewer health professionals caring for sicker patients with less resources.
Doesn’t reduce wait times
Those communities with the most privatization have the longest wait times. Statistics Canada found that Montréalers have the hardest time finding a family doctor. Montréal has a large number of “boutique” physicians clinics that charge huge fees for elite programs and special access. When Ontario introduced a private cancer clinic, wait times were unchanged a year later - and prices were higher. There is no evidence that private for-profit facilities have any affect on wait times in the public system.
Get informed — Get involved
For more information on the threat to Canada’s health system from privatized, for-profit care, check out our website: www.medicare.ca
Private, For-Profit Clinics [304 kb]
