Recent news reports about private payments for medically-necessary procedures in British Columbia tell an important story about a group of desperate people who are being oppressed by those in power.
But based on headlines castigating “double-dipping” doctors conducting “illegal” activities, one might mistakenly think that physicians are the antagonists in the story.
The real oppressor, however, is the government whose laws have led to a system where patients who need medical treatment must wait in pain and are denied the opportunity to transparently seek alternatives in their own country.
What motivates patients to use their own money for health-care services from private clinics when a “free” public alternative is available?
Long waits for treatment in the public system.
In 2016, the Fraser Institute estimated that patients could expect to wait 20 weeks between referral from a general practitioner to treatment – the longest wait in the history of the survey and more than twice as long as in 1993, when the first national estimates were produced. In fact, for some specialties the wait is much longer. For example, patients could expect to wait 46.9 weeks for neurosurgery, 38 weeks for orthopaedic surgery and 28.5 week for ophthalmological procedures.
While some patients may be able to wait for treatment without suffering adverse consequences, many others may be in pain, unable to work or live full lives. It’s no wonder some chose to seek alternatives even when fully aware that private treatment for medically necessary procedures is discouraged by provincial and federal governments.
Why do these waits exist and what can be done about them?
They exist because the government can’t fund enough services to keep up with demand. Consequently, medical services are rationed through waiting lists. And, unfortunately, government policy prevents the situation from improving by discouraging the private sector from helping expand supply, and by prohibiting co-payments and user fees, which could help temper demand.
Of course, whenever these types of reforms are suggested, opponents claim that they’re incompatible with universal health care. But in reality, Canadian restrictions on cost-sharing and private health care have little to do with the concept of universality.
A quick glance at other more successful universal health-care systems such as Switzerland, the Netherlands, Germany and Australia reveal that the private sector is a common ally in the delivery of universal care, and co-payments are a common expectation of patients (with exemptions and limits for vulnerable populations). Notably, these countries spend roughly the same as we do (Switzerland more, Australia less) but have shorter wait times.
And yet, many journalists and politicians ignore this and simply vilify physicians who provide care for patients who’ve been left to wait, suffer and sometimes wither and die in the public system. Worse, threats to crack down on private care will harm patients who will have fewer options for recourse.
This is not a story of evil physicians taking advantage of patients. It’s one of a public system that has failed patients, trapped by government policy and forced to seek treatment on their own, regardless of what provincial and federal policy-makers allow.
It’s high time policy-makers realize that the very policies they use to “protect” our universal health-care system are ensuring its failure.
Bacchus Barua is an economist at the Fraser Institute.
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