Don’t let the chaos of private health care become the norm, say researchers

Private health care providers are blurring the lines when it comes to the outsourcing and payment of health care, to the detriment of patients and health care workers, say researchers studying health care privatization in Canada.

Researchers from across Canada gathered at the University of Ottawa on June 20 to discuss their insights on the Canada Health Act. The research roundtable was organized by the Canadian Health Coalition and the University of Ottawa’s Centre for Health Law, Policy and Ethics with support from St. Thomas University.

The panel, “Creeping Privatization of Health Care,” is now available for viewing here:

Long-time researcher Kevin Skerrett, with the Ottawa Health Coalition and Ontario Health Coalition, moderated the panel on privatization. He highlighted recent disturbing developments at an Ottawa hospital as an example of privatization. A group of doctors at the Riverside campus of The Ottawa Hospital formed a private, for-profit company, Academic Orthopedic Surgical Associates of Ottawa Inc., and have been allowed to perform surgeries within the hospital.

“We have a group of surgeons working for our public hospital that have privatized themselves and contracted with the CEO of the Ottawa Hospital to perform surgeries,” said Skerrett.

The Ontario government has defended the practice as solving the surgical backlog problem while others want the problem solved through investments in the public health care system.

“There is no reason why additional surgeries could not be done in Ontario public hospitals,” Dr. David Urbach, head of the department of surgery at Women’s College Hospital in Toronto told CBC in March 2023. “There are many operating rooms in Ontario hospitals that are unused — but could be used — due to lack of funding and staffing, especially nurses.”

Andrew Longhurst, a PhD candidate at Simon Fraser University, has produced many research papers on health care privatization in Ontario, Alberta and British Columbia. He shared with the Research Roundtable audience that public health care, free at the point of delivery, is threatened by the incursion of corporate health care providers and private payment.

Longhurst focused on the contracting out or outsourcing of health care, when publicly funded services are contracted to for-profit providers, a phenomenon that he notes was pushed starting in 2010s and has continued to expand. He used Freedom of Information requests and publicly available data over the last ten years to review health care outsourcing developments and evidence of unlawful private payment in British Columbia, Alberta, and Ontario.

For Longhurst, outsourcing is really “entrenching one form of privatization with another.” Longhurst described how the British Columbia government has been negotiating more contracts with private clinics to provide beneficiary services as a way to prevent extra-billing for services. Longhurst noted that the outsourcing of surgeries in British Columbia doubled in the past decade from 2.5 per cent of surgeries in 2007/08 to 5 per cent in 2021/22. Meanwhile, the percentage of surgeries that are outsourced in Alberta is 20 per cent. 

British Columbia is home to an entrenched physician/investor-owned for-profit health care system, according to Longhurst. For the period of 2022-2023, the province has had the most extra-billing in the country.

“We need to be attentive to this interplay and this dynamic that we are seeing across this country. We have an increasing discourse from private interests, from some surgeons and physicians and from a number of provincial governments to say that this is a benign form of for-profit involvement the health care system,” said Longhurst.

“We need to understand for-profit delivery or outsourcing as a gateway to two-tiered health care because we have to understand that inherent to the for-profit business model of a lot of these investor-owned facilities is the mixing of public and private payment,” said Longhurst.

Longhurst cautioned that public sector outsourcing appears to be a preferred corporate strategy that blurs the lines between publicly funded, for-profit delivery (free at the point of delivery) and private payment contrary to provincial and federal legislation.

Dr. Danyaal Raza and Dr. Sheryl Spithoff, members of Canadian Doctors for Medicare, discussed their research on how virtual care companies are handling the data of patients and the risks to patient privacy. They interviewed “industry insiders” to identify pathways in which commercialization of data is occurring, as well as risks to patient privacy.

From Raza and Spithoff’s presentation –

The companies collect data such as names, emails, and browsing history as patients accessed care to then target ads or send marketing emails for “in-house” or third-party products and services. One insider reported, “If you are frequently looking up dermatology terms on our app, we might offer additional services around dermatology for you.” These services are often paid privately with higher markups than publicly funded services, what’s known as “sell-up conversions” in the for-profit care world.

Industry insiders also described how some companies were funded by pharmaceutical companies to analyze patient data, and adjust care pathways with the goal of increasing uptake of a drug or vaccine. Such data practices expose patients to potential harm not only from micro-targeting for commercial gain, but privacy loss, and discrimination.

Rebecca Graff-McRae with the Parkland Institute described what she called the “lab services rollercoaster” in Alberta since 1994. Alberta’s laboratory services have been marked by failed contracts, corporate bailouts, skyrocketing wait times, diminished access, and inadequate investment in space, equipment, and workforce. Graff-McRae noted Alberta Premier Danielle Smith addressed the chaos in Alberta’s privatized lab services by bringing the services back under the provincial health authority and its subsidiary.

Author of “Misdiagnosis: Privatization and Disruption in Alberta’s Medical Laboratory Services,” Graff-McRae described the toll on the workers being shut out of consultations and “labs being utterly blindsided by decisions that affect their entire existence” and how that “has come to be the norm, not the exception.”

“What we see now within the lab workforce is a deep sense of demoralization, pervasive uncertainty, dealing with logistical pressures around changing employers, changing unions, changing sometimes the locations of their job, the ongoing labour disputes… on top of pandemic burnout, a demographic shift within the workforce that’s happening nationwide and there’s an overwhelming sense of being used as a political football,” said Graff-McRae.

Lab workers, “the heroes of the pandemic,” told Graff-McRae that “nothing is sacred,” and that they feel expendable and “we need to be prepared to fight for every part of it.”

This is the second of a series of eight weekly blogs summarizing what was heard at the Canada Health Act at 40 Research Roundtable at the University of Ottawa on June 20, 2024. Next week’s blog will discuss the Winning Pharmacare panel with Marc-André Gagnon, the Council of Canadians’ Nikolas Barry Shaw, and Dr. Joel Lexchin. Previous webinars can be watched on the Canadian Health Coalition’s Youtube channel.

Tracy Glynn is the National Director of Projects and Operations for the Canadian Health Coalition