Canadians More Open to Private Health Care

Canadians More Open to Private Health Care

A TIPPING POINT? It caught almost everyone by surprise, the decision last month by St. Paul's Hospital in Vancouver to contract out 947 publicly funded surgeries to three private clinics. But as a sign of the times - of the national mood, in fact - it was right up there with Ralph Klein's, or for that matter Gordon Campbell's, bellowing calls for health-care change. That's because St. Paul's is not some creaky old institution. It is a UBC teaching hospital with 500 beds, 800 doctors and about 1,400 nurses. But for want of a dozen speciality nurses in its OR - over a six-week period, a handful retired, two others returned home to Australia, one moved because of her husband's job - the hospital realized it just couldn't cope. So it turned to the private sector.

There was precedent for this. Back in May, when B.C. hospital workers went on strike, private speciality clinics were called in, with the Campbell government's blessing, to help clear a backlog of some 5,000 surgeries across the province. But when St. Paul's elected to contract out this new batch of cases, to deal with what was essentially just an everyday crisis in the system, it was a striking endorsement of the growth and maturity of the for-profit operations. "All we've ever wanted was to be seen as partners in the system," says a delighted Dr. Mark Godley, medical director at False Creek Surgical Centre, one of the three picking up St. Paul's slack. It seems that's exactly what Canadians want as well - more coordination to get rid of the long waits.

According to this seventh annual Health Care in Canada survey, a solid 53 per cent of Canadians favour contracting out - that is, allowing medicare to pick up the tab for routine surgeries like knee or hip operations at private clinics - to deal with a public system that can be painstakingly slow. Only in Atlantic Canada and Ontario is there more opposition than support. In Quebec and B.C., substantial numbers (45 per cent in each province) are so riled at wait lists they are willing to pay out of their own pockets for quick access - the two-tier proposition that is vigorously opposed in the rest of the country.

Public mood can change, of course. In fact, this year's support for contracting out is down slightly from 57 per cent a year ago, possibly because the intervening federal election brought these emotive issues to the fore. But the political shorthand is clear: with two key qualifiers - no user pay and no resorting to personal wealth to jump the queue - Canadians appear just as ready for Klein's vision of medicare as for Paul Martin's. And why not? With no cumbersome labour rules and three state-of-the-art ORs running seven days a week, sometimes until 10 or 11 at night, False Creek can do 450 day or overnight surgeries a month, Godley says. What's more, he claims, his OR nurses are happier: the pay is better and the hours more predictable. For a generation raised on retail convenience, this seems to be how the system should work.

BROADLY SPEAKING, Canadians are still very wary about their health-care system, though they are less pessimistic today than in previous years, according to the Maclean's/Rogers Media poll, conducted by Pollara Inc. But Canadians are also very much in restructuring mode. The shortage of doctors and nurses is top of almost everyone's mind. And there is huge interest in the kind of change Ontario is trying to get its doctors to buy into - like requiring patients to register with a particular health-care provider, and requiring physicians to work in teams with nurse practitioners and other docs. In this, public opinion is well ahead of that of the medical profession.

So what lies ahead? At least two other health authorities, in the Interior of B.C. and in Calgary, are currently contracting out space in private clinics to deal with backlogs. Ontario and Manitoba, on the other hand, have just bought out a handful of private MRI clinics to bring them into the public system. The debate is far from over.

No one knows exactly how many private clinics there are in Canada. There are probably no more than a score that can offer a broad range of surgeries; maybe 50 or 60 more if you include those offering MRIs and other high-end diagnostic services. And while private clinics have grown in number and size over the past few years, they are still primarily limited to services not covered by medicare. (Laser surgery for prostate removal, for example, is a False Creek speciality.) They also treat people given legislative exemptions - such as injured employees on worker compensation or the RCMP - which of course creates two classes of patient, one getting more timely care.

That's the basis of a grievance now before the Supreme Court - a case, some say, that could crack medicare wide open. Known as Chaoulli and Zeliotis vs. Quebec, this is a five-year-old appeal of a decision involving a Montreal doctor and his patient who, upset at the long wait for hip replacement, wanted Quebec to order it done expeditiously at a public hospital, to be paid for by private insurance. Not surprisingly, dozens of interveners have weighed in, from provincial governments to large labour unions to a coaliton of private clinics. It is hard to imagine the Supreme Court taking a jackhammer to medicare when it decides this matter, likely early next year. But it may not have to. By March, the bills will be in from the St. Paul's experiment, and any public savings will be there for all to see. Couple that with the ruthless pragmatism in public opinion. Change is going to come.

THE POLLSTER WILL SEE YOU NOW

CONTRACTING OUT

Do you support or oppose allowing government to contract out delivery of publicly covered services to private clinics, for instance having medicare pay for knee surgery at a private clinic rather than a hospital?

Strongly support 19%

Support 34%

Oppose 23%

Strongly oppose 19%

FORCING CHANGE

Percentage of Canadians who would:

Require patients to register with one family doctor 69%

Require providers to work in teams 86%

Require professionals to work in locations they are needed 79%

CONFIDENCE

Would you say your confidence in the health system is rising, falling, or about the same?

2004 1999

Rising 6% 5%

Falling 47% 55%

Same 45% 38%

FIXING THE SYSTEM

Percentage of Canadians who say:

Fairly major repairs needed to health-care system 54%

Not enough doctors 86%

Not enough nurses 81%

Not enough health-care managers 21%

DEALING WITH SHORTFALLS

Percentage of Canadians who support:

Restricting services 21%

Asking patients for co-payments 34%

Levying a health-care tax 41%

Finding money from other government services 65%

ACCESS

Percentage willing to pay out of their own pockets for quicker access:

Atlantic Canada 37%

Quebec 45%

Ontario 24%

Prairies 35%

B.C. 45%

Total 35%

SOURCE: POLLARA INC. OF TORONTO

SAMPLE SIZE: 1,034, WHICH MEANS RESULTS ARE DEEMED ACCURATE ± 3.1%, 19 TIMES OUT OF 20

See also HEALTH POLICY.

Maclean's December 20, 2004