Private healthcare: a threat or an ally to the public system?
At the invitation of the Conseil des entreprises privées en santé et mieux-être (CEPSEM), QMA president Dr. Hugo Viens gave a presentation on May 17 about the issues related to the public‑private dynamic in the healthcare system.
In Dr. Viens’ opinion, the healthcare system clearly needs to be efficient, responsive and accountable, which is why we need to ask whether private healthcare is well and truly a threat, or whether it might be an ally to the public healthcare system.
“It’s time we rethink the way our healthcare system works, see it in a different light, and develop innovative solutions,” Dr. Viens pointed out.
A close look at the healthcare system reveals private services everywhere. The basket of services covered by the Québec government is centred on hospital care and medical acts performed by physicians. Yet, many health services that are essential, and even medically necessary, are not covered for a large proportion of the population (dental care, rehabilitation, social services, etc.).
The healthcare system is already rife with private services
A large portion of the healthcare system also falls under the private sector. In fact, nearly half of the government’s healthcare spending goes to private companies. With the exception of CLSCs and hospitals, medical services are provided at private offices, in family medicine groups, at super-clinics, and at polyclinics. And most of the expenses (for services, technologies, machines, transportation of materials, etc.) and equipment investments made by public institutions, such as hospitals and CLSCs, go to private companies.
Finally, since a large percentage of physicians are incorporated, their salaries are in fact paid to private entities.
Our “public” system is therefore a public payment system rather than a public resource management system. And not only does a large proportion of government spending end up in the hands of private companies, but the private sector already plays a large role in the operation of the healthcare system.
The population wants publicly funded healthcare
Moreover, when the population is asked what they want, their response is: quality healthcare, within reasonable wait times, paid for by the government. According to a CROP survey conducted as part of a 2017 study by Pôle Santé HEC Montréal, close to 70% of the population thinks it’s normal that several different types of organizations (private, non-profit or cooperative) can provide government-funded health and social services.
“Who pays the rent has no bearing on the patients. What matters is who pays for the health services,” Dr. Viens stressed. So, the taboo of private healthcare is a myth, and the QMA is unanimous in its position that medically necessary services must be covered by the healthcare system, regardless of who provides the service.
Private when it’s an added value
In this sense, there needs to be openness to going private in situations where this would add value to our health services. Dr. Viens then cited the example of the Chirurgie DIX30 clinic, where he is a partner, and of which he is the medical director. This clinic, which performs strictly day surgeries, is equipped with flexible, lightweight infrastructures that allow it to save money. As such, it is more efficient and responsive than very large infrastructures, such as hospitals.
As a private funded structure, it provides only services that are covered by the public plan, meaning patients don’t have to pay for the services they receive there. Their care is paid for by the companies who send their employees to the clinic. Other patients are transferred there by three local hospitals as part of a patient-centred activity-based funding pilot project. The government is actually in the process of establishing the cost of care episodes before implementing this type of funding in Québec hospitals. Two other clinics are also participating in this project.
Greater openness to private funded structures expected
Not only are patients satisfied with the quality of their care and the speed with which they are treated, but the professionals involved, including the physicians, are more efficient given their accountability, which is inherent to any private company. So, this is a good example of the public interests being served by the private sector.
Following Dr. Viens’ presentation, participants discussed the future of the healthcare system. Due to the system’s current performance and its instability following recent reforms, they feel that future governments are likely to resort to private funded structures as a means of supporting and improving the performance of the healthcare system.