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For-profit health care undermines medicare, decreases access

July 4, 2014
Monika Dutt, Cape Breton Post

When the College of Physicians and Surgeons of Nova Scotia stated its intention to regulate private care, and Health Minister Leo Glavine said he would begin to look at a legislative framework for private health care, they started a provincewide debate about the implications of inviting privatized practice into the health-care system.

Many individuals and organizations throughout Nova Scotia have opposed this acceptance of private care as harmful to our universal health-care system.

There is a key differentiation that needs to be made between private for-profit and private not-for-profit delivery of health care.

For-profit health care undermines medicare and decreases access, primarily by granting services based on ability to pay, not need.

Private not-for-profit health care describes services that are funded by medicare, but delivered privately, and includes most physician offices.

It is the former that is of particular concern, and it is essential that regulatory bodies subject it to the necessary scrutiny.

All Nova Scotia health-care services need to be regulated to ensure that patient safety is maintained and that the publicly funded medicare system is not threatened.

Regulation with enforcement can ensure that harmful practices — such as overbilling, block fees and unnecessary procedures — do not occur. Health care that contravenes provincial regulations or the Canada Health Act should not be allowed.

Any model of care or health-care service, whether delivered publicly or privately, must serve the best interests of Nova Scotians. When it's done right, new models can improve care, expedite services and reduce costs — advantages that everyone can appreciate.

To help ensure positive outcomes, the organization Canadian Doctors for Medicare uses four criteria to assess changes to health-care delivery: Equity; high-quality care; delivery of effective and clinically indicated services; and effective planning and integration.

Currently, there is an exciting window for Nova Scotia to incorporate these criteria into legislation regarding private health care, while maintaining its universal, publicly funded system. These criteria were incorporated into previously proposed legislation, which banned extra billing, queue-jumping, and user fees. Unfortunately, that law was never finalized. It's time to revisit and enact this plan to safeguard single-payer universal health-care service in Nova Scotia.

Regulation should prevent private clinics from using their access to patients in the public system as an opportunity to recruit for other services, a practice which frequently occurs in for-profit settings.

There must also be regulations in place to ensure there is no erosion over time to allow for the queue-jumping, cherry-picking (only treating the healthiest patients), extra billing and worse clinical outcomes that have characterized for-profit facilities in other provinces.

The last criterion, planning and integration, is the most challenging to attain. Private clinics must collaborate with other health-care institutions. This includes collecting and sharing information in a secure manner, and linking patients with appropriate community services, as would be expected in a public, non-profit setting

Creeping for-profit care is not the answer to addressing needs in our health-care system; better medicare is the answer.

What does better medicare look like? For a start, it involves moving services outside the hospital and into the communities Nova Scotians live in. That includes not just family medicine, but home care, and certain surgical or other specialized services. It means making sure the rules that govern these new services keep Nova Scotians safe and healthy.

Some of these services may be delivered by the government, others by doctors, nurses or community groups, while still funded through the public system. Regardless of who delivers the services, they will only serve the best interest of Nova Scotians when properly regulated to ensure they enhance our public system rather than destabilizing it.

Dr. Monika Dutt is chair of Canadian Doctors for Medicare, and a public health and family doctor in Cape Breton.