More private health care in Quebec
The Journal is looking at the incursion of private health care Thursday: a woman whose case was transferred to the private side without her permission, meaning she had to pay $200 for a test, a woman in need of orthopedic surgery for years hearing suggestions to go private, doctors fleeing the public side for more profitable private practice.
Why is nobody standing up for the Canada Health Act?
DeWolf 11:34 on 2023-07-06 Permalink
So it took a call from a journalist to get the woman reimbursed, and the clinic direction claims it was a mistake that has never happened before. Sure.
This kind of crookery is exactly what the Canada Health Act is meant to avoid, and as you say, nobody seems interested in standing up for it. From what I can tell, this kind of insidious privatization is happening in nearly every province.
carswell 11:35 on 2023-07-06 Permalink
My GP is going private in September. Received the fee schedule recently. She’s offering two options. All-included VIP service costs $100/month or $1100/year. À la carte service is $300 for the first consultation for any given issue, $200 for each followup, forms $100-$400, email $100, prescription renewal $75 “each” (unsure whether that means per drug or per script).
Went to the government website to get on a waiting list for a new GP and was refused access because I already have one…
It’ll soon be like it is for dental work: unaffordable for many, a huge burden for many others and a trifling annoyance for the affluent, who will also receive better care. We’re looking at a two-tier healthcare system in Canada. Tommy Douglas must be rolling in his grave.
walkerp 11:44 on 2023-07-06 Permalink
It’s so distressing while our leaders fight over election security angels dancing on a pin.
Mark Côté 11:49 on 2023-07-06 Permalink
This Globe and Mail article was really interesting. Law of finished consequences in action.
carswell 12:30 on 2023-07-06 Permalink
@Mark Côté Though the headline (“How Ottawa can help fix health care: first, send less money”) doesn’t inspire confidence, the article is paywalled, so non-subscribers can’t put it in context. Care to summarize or provide a gift link?
mare 12:36 on 2023-07-06 Permalink
If you know under which stress GPs have to work under and how much they get paid you’d understand why they go private. I would.
My GP ‘inherited’ all patients from one of his colleagues who retired and the last appointment of the day with him is at 16h. I’ve had that appointment slot a few times and was seen at 19h pm. He starts at 8h. No wonder that getting an appointment is very hard, with a few weeks waiting time, and you have to book through a ridiculously bad website. I usually call, and his assistant has directed me to go to the ER a few times, for relatively minor issues. Which means long waiting times at ERs, people being stressed and annoyed there etc.
They (have to) see a ridiculously high number of patients per day. Which means they might not have enough time to pick up on serious issues until it’s too late. Also because their referred patients end up on ‘black hole’ waiting lists at also overworked specialists. This results in people being seen in hospitals when their disease is already in an advanced stage which, in the long run, costs more money and scarce hospital and long term care resources.
(Or, if you’re cynical, less money when they die at an earlier age. But, as someone in the field once told me, the government doesn’t have to pay doctors and specialists who aren’t there. People working in healthcare are pretty cynical.)
Covid has exacerbated the shortage even more. Not only nurses but specialists are also sick at home with burnouts and Long Covid.
Going private as a GP means they can start over and take fewer overall patients and see fewer of them each day and take proper care of them. If the patients have money or generous private insurance they can then refer them to private specialists with short waiting lists. Specialists who can even perform quite complicated surgeries. (And can offload their worst patients to the public healthcare with high urgency.)
mare 12:39 on 2023-07-06 Permalink
@carswell The globe article above: https://archive.ph/mQuCB
jeather 13:22 on 2023-07-06 Permalink
There are so many weird details about it. Specialists go half half, and tell the public system people that they will be private from July-Dec so they could get [whatever] done then, or just stay on the list. GPs are not required to find new doctors for their patients if they retire or leave the system, but ARE if they go part-time. If you work as a specialist in a hospital, you must take your evening or weekend hours no matter your age, there’s no seniority system at all there.
A friend was also transferred for some exam to a private clinic, but she wasn’t asked to pay.
MarcG 15:50 on 2023-07-06 Permalink
How much of this shift is related to McKinsey working its way inside of our governments?
Tim 21:52 on 2023-07-06 Permalink
@Carswell: some facts regarding dental services as of 2010 (I could not find anything more recent):
80% of Canadians had a dentist
85% of Canadians had seen a dentist in the past two years
Source: https://www.cda-adc.ca/stateoforalhealth/_files/thestateoforalhealthincanada.pdf
Do you have any stats to back up your assertions as to how “many” cannot see a dentist? What’s your definition of affluent?
steph 09:41 on 2023-07-07 Permalink
Being a doctor is something to be proud of. The ones that go private don’t deserve that respect anymore.
carswell 10:51 on 2023-07-08 Permalink
@mare. Thanks for the link.
I count several physicians among my friends and acquaintances, including a couple in administrative positions, and have heard the horror stories first hand. I would even argue that doctors are in an abusive relationship with the government: forced to give up control of their schedules, make huge compromises in their personal life, adopt schedules that are regimented to a degree I find unimaginable, set up extensive support networks just so they can function. I see how harried my GP is. I and other patients have, of necessity, become a commodity; there’s not even a minute for small talk (which there should be, as it’s often revealing of a patient’s issues). It makes me glad I abandoned pre-med at university.
That said, these friends and acquaintances are also among the most comfortably off people I know. To a person, they live in deluxe accommodations. At dinner parties, conversation often centres on which fabulous vacation spot they’ve just returned from or are heading to next (a villa on Lake Como and a luxury wine tour of South Africa are two I recall), on which BWM model to buy next, and so on.
Aside from the blackout, one of the reasons I’m tardy in replying is because yesterday I could finally get my blood and other tests done. My doctor had ordered them in early May. It used to be I could take the forms, walk over to St. Mary’s or the Jewish, wait a half hour or so and have the samples taken. Last time I had to make a reservation at St. Mary’s for later in the week, understandable given the pandemic and the need to avoid crowding. This time, I had to go through the ClicSanté website and the Jewish didn’t have an opening until late August (nearly four months!) or St. Mary’s until the end of July. The delay at the local CLSC was more like seven weeks and I snagged the last spot.
Our health system is crumbling and while there are many factors at play, government incompetence is chief among them. After presiding over a disastrous response to the COVID-19 crisis, our health minister should have resigned. Instead, he not only remains but is given even greater powers. Centralization of power and decision-making in the Health Ministry isn’t working. The solution? Centralize it even more and add an extra layer of administration.
So, no, I don’t hold it against physicians for opting out. Spending quality time with her patients was the first reason my soon-to-be-former GP gave when announcing her intention to go private. On the other hand, they are also are chasing to deal only with people who can afford to pay or have a private insurance plan. They are turning their backs on the less well-heeled, being aiders and abettors in the installation of a two-tiered health system. For now, though, I’ll direct my anger at the government.
carswell 12:16 on 2023-07-08 Permalink
Apologies for the extended typo in the last paragraph.
On the other hand, they are also choosing to deal only with people who can afford to pay or have a private insurance plan.
carswell 12:22 on 2023-07-08 Permalink
@Tim (and BTW it’s carswell, with a lowercase C to indicate it’s a handle) No, I’m not basing my assertion on stats. My information is purely anecdotal, based on what I hear from friends and colleagues and on my interactions with the dental “system,” which unfortunately have been frequent and costly in the last decade or so.
My cursory search for more up-to-date stats doesn’t turn up anything definitive either. For example, not that I’m a Dipper but the NDP website claims 1/3 of Canadians don’t have dental insurance and 7 million Canadians (36%, no?) don’t see a dentist every year because they can’t afford to, but no sources are cited.
Returning to “your” stats though, they leave a lot unsaid. What does “have a dentist” mean? A dentist they see at least every six months for a cleaning and checkup or a dentist they’ve dealt with at some point in the past? Ditto re “have seen a dentist in the last two years.” For a regular visit or because they were in such pain they couldn’t put it off any longer?
Even if we cast your stats in the best possible light, that still leaves 8 million Canadians without a dentist and 6 million who haven’t seen a dentist in two or more years. Hardly trifling numbers, especially when you factor in that they date from well before the current inflationary spiral.
As for affluent (and not sure why it matters), Webster’s definition works for me: “having an abundance of goods or riches.” Or, to phrase it more relevantly to this discussion, someone who can afford to pay without depriving themselves of necessities and at least the occasional nicety, someone for whom forking over a hitherto unbudgeted $1200 a year isn’t going to place a strain on them. While I could afford that amount now, I’m also planning to retire in five years and it would be $6000 less for my nest egg. Post-retirement? Unlikely without sacrifice. Which probably means I’ll be receiving inferior care when I most need it.
What I find especially galling is that, having been blessed with good health, I’ve spent 45 years paying a lot more into the system than I’ve taken out of it. Now, when I’m more likely to start making use of of the system, I’m presented with a stark choice: standard care (now termed “VIP”) that treats me like a person but with a premium I’ve not planned for or lesser care that treats me like a commodity.
Tim 22:46 on 2023-07-08 Permalink
@carswell: they are not my stats. They were produced by the Canadian Dental Association. I just referenced them.
As for my question about affluence. I was just curious if you could put a number on it. A family (with both parents working) making $120k a year, whom I would not call affluent, I guess meets your definition. Or maybe not.
I’m sorry to hear of the costs of your dental care. That is not small change.
What I am now surprised by, after another search for stats about dental insurance, is the following from the CDA, which indicates that there are far fewer people with dental insurance than what I thought:
“53% of adults between 60 and 79 years of age have no dental insurance and 50% of Canadians in the lower-income bracket have no dental insurance.”