Private medicine creeping in everywhere
I was struck while skimming the Guardian by the headline Private healthcare boom fuelled by NHS waiting lists. Individuals there are being forced to pay for private medical care, but the National Health Service is also paying private businesses for services it needs to deliver. It sounded depressingly familiar.
How did we all stop being able to believe that socialized health care is even possible?
Mark 09:31 on 2024-10-25 Permalink
I would replace “stop being able to believe” with “calculated effort to rip apart’…because dollars. There is so much money to be made in private health care that it’s too tempting for various actors not to try by all means to get access to that pie. Think about it, what would you be willing to pay anything for? If you need treatments, surgery, chemo, transplants, whatever critical medicine, all other expenses take second place, even food,house payments, etc. because those can wait.
Yes our population is aging, yes we had covid, yes governments have multiple crises to deal with. But let’s not be fooled for one second that we couldn’t have great public health care, especially in well functioning economies like ours that haven’t experienced wars or major natural disasters in decades. This is a slow 40 year process that started in the 80s, like crows picking at bits of roadkill.
David Senik 10:27 on 2024-10-25 Permalink
I would add that the political climate post 9/11 and GWB has been one of declining trust in institutions and in each other. Socialized medicine, like so many of the most valuable things in life requires us to trust in each other and the system. People are too cynical and as such are easily manipulated by the forces that Mark mentions above. It’s been frustrating to watch people act in a way that undermines their own interests because they believe that cooperation equals being suckered. We’ll learn again…eventually…I hope.
JaneyB 10:34 on 2024-10-25 Permalink
Quebec was the last province to join Medicare in 1970 and was even then, was very ambivalent. As a transplant, I will never understand this, especially since the financial vulnerability of families with 10 kids was much more acute than in the rest of Canada. Here’s a link to an advocacy group trying to protect public health care in Canada that provides data on the growing private system here in QC: https://www.healthcoalition.ca/growing-numbers-of-quebec-doctors-are-boycotting-public-health-care-in-favour-of-the-private-sector/
Via the Canada Health Act, the feds have the power to claw back from the transfer payments an equivalent amount of money that the citizens have spent privately. Unfortunately, it avoids doing this to keep the drumbeats of independence quieter. It’s hard not to think that many Quebecois voters value provincial autonomy more than they value affordable and prompt public health. In reality, those voters are increasingly ‘on their own’ when they have health issues. That’s not a very good kind of autonomy, imo.
Kevin 10:38 on 2024-10-25 Permalink
The WHO has a great interactive map about healthcare with an arresting visual: Canada doesn’t have very many doctors. https://www.who.int/data/gho/data/indicators/indicator-details/GHO/medical-doctors-(per-10-000-population)
We have fewer doctors per capita than everywhere in Europe except Albania and Bosnia & Herzegovina. We’re on a par with Libya, Brazil, and Mexico.
Doctors’ associations will tell you that training in other countries is not the same as it is here, but as a rule — Canadians are terribly underserved in this aspect of life.
We needed to start training more doctors and nurses 20 years ago, and failing that we need to drastically increase the number of med school admissions immediately.
Instead we have provincial governments that keep making dumbass decisions like imposing geographical limitations on where doctors can work, refusing to let family doctors work 5 days a week seeing their own patients, and refusing to let doctors or clinics hire their own administrators and receptionists.
Joey 11:59 on 2024-10-25 Permalink
Kevin’s point is really critical – every proposal (like Jane Philpott’s new idea of neughbourhood health clinics – cough cough CSLC cough cough) that doesn’t explain how we are going to increase the number of doctors per capital quickly is basically DOA. The task is all the more challenging because young doctors nowadays do not have the same commitment to workaholism that doctors did 20 years ago.
Blork 14:50 on 2024-10-25 Permalink
The issue of there not being enough doctors is an important one. It raises the question of WHY do we not have enough? Are we not training enough, or are we not RETAINING enough because some doctors might find working elsewhere more appealing (for various reasons)?
At the risk of sounding like I’m shilling for private sector medicine (I am not), I’d like to offer a more practical, and less conspiracist view of why private medicine is growing and popular with some people.
As with most modern technologies, medical technology is advancing rapidly and some of the new machines and practices are very, very advanced and futuristic. But they’re also very, very expensive. If a medical specialist wants to use that new cutting-edge whatever-machine in their urology or oncology practice, they might have to wait for years in the public system, which crawls at at a glacial pace when it comes to approving and spending on upgrades.
To get that fancy new thingamajig at a public hospital, the doctors have to lobby the administration, and if they’re successful in principle they then need to get the money. The hospital administration needs to justify it to the government, which means bringing a glacial process into a tectonic one. Years, maybe decades pass before that new machine shows up and can be used.
Whereas in private practice, if a specialist wants to use an expensive new machine, they assess the financial risk themselves, and if they think they can pull it off, they just go and buy it and start using it.
It’s like the CBC telling reporters in the 1980s that they have to keep using typewriters because computers are expensive and not proven. Screw that; go work for a private media company and you can use the computers. (That’s an analogy; I don’t know if CBC resisted computers. Probably not.)
Don’t underestimate the importance of this (the role of rapidly-advancing technology in the migration to the private sector). Doctors want to use the new advanced machinery and practices now, and patients want them too. The public system is just too big and slow and arduous and laden with processes and (necessary) accountability checking to keep up.
Note that hardly any doctors are going into private practice to do routine things like family medicine and the like. Most private practices are specialists using advanced systems that simply aren’t available in the public system.
Uatu 16:14 on 2024-10-25 Permalink
The Super Hospital is basically the thing blork is talking about. It has all the cutting edge stuff within the public system and more importantly it’s attached to the Research Institute which I overheard some doctors describe as a “hospital within a hospital” which I guess means there’s a wing within it where they’re trying out these new therapies. This is great for attracting the best and brightest doctors from everywhere (lots of Arab doctors) and getting big deal equipment like the latest MRI machines or the laser in the cancer center, but what about someone who just needs to see a doctor for a check-up? We focus so much on cures and drugs that we forget about catching the illness before it becomes acute. And there are a lot of doctors (especially female ones who want to have a family) who are choosing the private sector for better quality of life. Nurses too.
Like I said before, if the political class were forced to use the public system like we do then we’d have the best system. But it’s everyone for themselves it seems.
Blork 17:18 on 2024-10-25 Permalink
It’s great that the super-hospitals were set up with the intention of leaping ahead with medical technology, but I’d like to know how well they’ll be at keeping up with rapidly evolving systems and protocols. I worry it was a great leap forward to 2017 but that it might be stuck in 2017 until 2030.
DeWolf 21:39 on 2024-10-25 Permalink
Is the issue a lack of specialists though? From what I’ve heard that’s actually one of the strong suits of the system here in Quebec. Everyone I know who needs to see a specialist has been able to do so within a reasonable delay and the service has been excellent. The problem is a chronic lack of GPs and preventative care. It’s the basic stuff that is bad and getting worse.
Joey 10:18 on 2024-10-26 Permalink
“Note that hardly any doctors are going into private practice to do routine things like family medicine and the like. Most private practices are specialists using advanced systems that simply aren’t available in the public system.”
I am skeptical that is still true.
@DeWolf that doesn’t explain why cancer (and other) surgery wait times are so long.
Kate 13:02 on 2024-10-26 Permalink
My impression was that surgery waits are long at least partly because operating rooms are overloaded, plus a surgeon can’t operate alone, they need an anesthetist, at least one nurse or assistant, and everything has to be ready at the start time. This has to be difficult to orchestrate at the best of times.
JP 11:43 on 2024-10-26 Permalink
I agree with Joey. I don’t have stats but I’m fairly certain family medicine is undergoing privatization based on people in my network and where they’ve gone. It’s very difficult to find someone to see for fairly minor issues (that need to be checked) if you don’t have a family doctor like I do. I do miss the days when you could wake up early and line up at the clinic…that seems easier than just not being able to get an appointment at all anywhere.
Orr 13:41 on 2024-10-26 Permalink
I was good friends in my rural hometown in the 1970s with a family of doctors who were parents of my best friend and I heard stories about before medicare how many poor patients got billed for doctor calls but that these bills were never collected on, because obviously the people couldn’t afford to pay for them, and the doctors were compassionate people.