Healthcare privatization is no longer the taboo it once was. But would it help Quebec’s ailing system?

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It’s almost noon at the Tiny Tots Children’s Hospital on Decarie Square in the Montreal suburb of Côte Saint-Luc, and there’s a steady line of parents clasping their little hands or pushing strollers as they check in for their child’s appointment.

Tiny Tots is part of ELNA Medical’s growing network of family medicine and specialty clinics with approximately 96 clinics in Canada, including approximately 25 in Quebec alone.

Although many of the services are covered by public health insurance – in Quebec by the Régie de l’assurance maladie du Québec (RAMQ) – the clinics are privately owned and operated.

When patients need to see a specialist, they can be referred internally to someone who works at one of the ELNA clinics. A patient may have tests or procedures performed at a public clinic or at ELNA. Some specialty procedures at ELNA are covered by RAMQ, while others are mostly covered by private insurance plans

“It’s the same care except for, say, a better shell,” said Dr. Benjamin Burko, the Montreal-based company’s pediatrician and chief innovation officer.

Support for such an approach appears to be growing.

A shortage of GPs, long waits for surgeries, and overcrowded emergency rooms have left the public thirsty for new ideas to improve Quebec’s healthcare system — and one of the key alternatives being proposed in this campaign is to open the network to further privatization.

Both the Coalition Avenir Québec (CAQ), which has a significant lead in the polls, and the Quebec Conservative Party (PCQ), a rising right-wing party, have put forward proposals to expand private care.

Outgoing Avenir Québec coalition health minister Christian Dubé, left, and party leader François Legault announced plans for two large private clinics during a campaign freeze earlier this month. (Graham Hughes/The Canadian Press)

In an attempt to relieve pressure from nearby hospitals, the CAQ is proposing two new private medical centers in east Montreal and in Quebec City. The privately run “mini-hospitals” would be open seven days a week and would include a family medicine clinic, a 24-hour emergency room for minor ailments and day surgeries. According to CAQ, all of this would be covered by statutory health insurance.

The PCQ wants to go further, and party leader Éric Duhaime said the “p-word” is no longer taboo when it comes to healthcare in Quebec.

Duhaime wants private companies to be allowed to run some hospitals and believes doctors should be encouraged to practice in both the public and private healthcare systems.

Quebecers are open to ideas

Proponents of more privatization argue that it would take pressure off the public system and improve triage care, but many experts say it would drain resources from the public system and increase injustice in the process.

“Having a private network competing with the public system is not a solution to the public system’s labor shortage,” said Olivier Jacques, an assistant professor in the Department of Health Management at the Université de Montréal.

Jacques said private centers like those proposed by the CAQ could steal doctors and nurses. It’s unclear whether such a model would lead to a more effective use of taxpayers’ money, he said.

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A nurse and doctor discuss campaign promises in Quebec

Nurse Natalie Stake-Doucet and GP Dr. Michel Minh Tri Tran say more resources and flexibility are needed to provide patients with the care they need in a timely manner.

But the ideas floated during the campaign suggest that Quebecers aren’t as attached to the idea of ​​public health care as residents elsewhere in Canada, Jacques said.

A current survey by Angus Reid confirms this. It found that Canadians were among the most hungry for more private care, with 40 percent saying more private care would help. (Quebecians are also among those most dissatisfied with the current system, with three in five respondents saying the care is poor.)

Likewise, 43 percent of Quebecers who have attended CBCs tune compass Survey wants more private health care, while 26 percent want the same amount and 31 percent want less.

Importantly, Jacques noted, “No one is saying people should pay more for healthcare themselves. So it’s not about funding the healthcare system, it’s about delivering services, and that’s a whole different thing.”

“Less Access”

In Canada, healthcare spending is split between the public and private sectors with a roughly 75-to-25 split, according to the Canadian Institute for Health Information (CIHI).

Quebec has a slightly higher proportion of public coverage due to coverage for prescription drugs and other ancillary services.

The CAQ and PCQ proposals have been criticized by the Quebec Liberals, but they too promise to allow more private clinics covered by public health insurance to address the surgical backlog.

The Parti Québécois and Québec Solidaire reject an expansion of private care. Both plead for more funds for the public system.

McGill Prof Amélie Quesnel-Vallée, Canada’s Research Chair in Policy and Health Inequalities, pointed out that the province already has more private care than much of the public realizes – starting with the doctors themselves. They are mostly self-employed and include some who have retired from the public system fully or part-time.

In the past five years, the number of specialists and general practitioners in the private system has increased by 35 percent – by more than 500 doctors in total. Private clinics are a large part of the patchwork of provincial care, reinforced by a landmark 2005 Supreme Court ruling which allowed Quebec residents to purchase private health insurance.

A woman stands in front of a hospital
Isabelle Leblanc, GP at St. Mary’s Hospital in Montreal, is running for Québec Solidaire in the Mont-Royal-Outremont race. (Benjamin Shingler/CBC)

Isabelle Leblanc, a family doctor at St. Mary’s Hospital running for Québec Solidaire in Mont-Royal-Outremont, believes the province has already gone too far towards privatization.

A former president of the advocacy group Medecins Québécois pour le public regimeLeblanc is concerned about the erosion of the public health system and what it means for the most vulnerable.

“The main reason, you know, is that a private clinic is there to make a profit. She is not there to take care of people and she will choose her patients.”

Your party advocates putting more money into CLSCs.

“There is less and less access” to health care providers like psychologists unless you have private insurance or the means to pay out of pocket, Leblanc said.

“15, 20 years ago people could just go to the CLSC and see a physical therapist, a psychologist or a social worker and they had access. Access is very good now [limited].”

She said the money set aside for the CAQ’s proposed east Montreal clinic should instead be used to transform Maisonneuve-Rosemont Hospital.

“Major renovations need to be done here,” she said.

Privatization requires “a different pace”

Burko began his medical career at Montreal Children’s Hospital but said he left the hospital after becoming frustrated with what he saw as a slow and inefficient system.

He was CEO and medical director at Tiny Tots for 30 years, which he sold to ELNA Medical in 2017.

Private clinics operate in a market economy, which he believes encourages a better patient experience. To remain competitive, private clinics must compete for doctors and make the experience as efficient as possible to keep patients coming back, Burko said.

“Government institutions like hospital clinics are never under this pressure,” Burko said.

“The incentives aren’t there. It’s a different pace and it accepts things that would never be accepted in a private company.”

A man stands in front of a sign for his clinic
dr Benjamin Burko, ELNA Medical’s chief innovation officer, says while privately run clinics have many advantages, the government must first address the labor shortage. (Dave St-Amant/CBC)

Given his support for the private system, it may come as a surprise that Burko, as a longtime doctor, isn’t a fan of CAQ’s proposal to build privately run super-clinics, which he fears will cannibalize staff.

It’s “Robbing Peter to pay Paul,” Burko said. “There aren’t enough doctors anywhere, so a fancy new building with nice furnishings won’t really be a solution. Either it stays vacant or you pull staff from other places.”

He would prefer the province to invest in training more doctors and nurses to address labor shortages.

The details of the CAQ proposal aren’t clear yet – but in general, critics say private healthcare providers tend to handle simpler cases while leaving out more complex treatments an overburdened public system.

Still, Quesnel-Vallée said private sector involvement could be fruitful provided it didn’t just exacerbate labor shortages.

“We need some transparency on what the government is paying for these private services and how that compares to what’s currently on offer in the system,” she said.

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