Case Study: Should there be more space for healthcare privatization in Canada?
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Lesson C: Constructive Discussion
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Discussion Prompt
Should there be more space for healthcare privatization in Canada?
General background
“Medicare” is a term that refers to Canada’s publicly-funded healthcare system. Instead of having a single national plan, Canadians have 13 provincial and territorial healthcare insurance plans. Under this system, all Canadians have access to medically necessary hospital and physician services without paying out-of-pocket.
The roles and responsibilities for healthcare services are shared between provincial and territorial governments and the federal government. The provincial and territorial governments are responsible for the management, organization and delivery of healthcare services for their residents.
In recent years, healthcare systems across Canada have experienced increased wait times for services, including for medically-necessary procedures and in emergency rooms, sometimes leading to tragic consequences. For example, in November 2023, a patient in a Winnipeg ER died after waiting over 33 hours for bed. Only a month later, in Québec, two patients died while waiting to be treated in an emergency room that had been operating at double its capacity for weeks. This ongoing situation has also led to doctors and nurses working longer hours, reporting higher rates of burnout, and, in some cases, leaving the profession entirely.
While the vast majority of doctors in Canada operate under Medicare, it is possible for them to opt-out (with the exception of doctors in Ontario). Doctors who opt out of medicare charge their patients entirely out-of-pocket for their services. However, in most provinces, significant barriers exist in order to limit private practice. Québec is the only province where a significant number of doctors work in private clinics.
Some have argued that creating greater space for private healthcare delivery could help ease the burden on public clinics and hospitals, reduce wait times, and help retain staff. However, opponents argue that private healthcare comes at a steep cost to taxpayers, as private clinics charge well above the cost of procedures in public settings. There are also concerns that opening the door to privatized healthcare is a first step towards dismantling the public healthcare system.
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Agree
Here are some reasons why people might argue that we should allow for more privatization in Canadian healthcare systems.
Increased access to healthcare
Canadians are facing unprecedented challenges in accessing the care they need. Delayed procedures not only cause stress to patients and their families, they can also lead to deaths that could have been prevented. Creating more space for private healthcare would give citizens more options to ensure they can be treated in a timely manner.
No additional cost to individuals
Private healthcare does not necessarily mean increased costs on individuals. Many private health clinics across the country already deliver public services, meaning that the care they provide is paid for through Canada’s taxpayer-funded Medicare system. Most proposals for healthcare privatization are built around the concept of “private delivery of public care”, an approach which results only in positive outcomes for patients, who receive faster service at no cost.
Reducing the workload of healthcare staff
Canadian healthcare staff have been overburdened for years, and the COVID-19 pandemic made these issues worse. As a consequence, a significant number of doctors and nurses have moved from public to private institutions, or switched careers entirely. Hiring new staff is certainly the long-term solution, but in the short-term the government may need to hire private staff, even if it does cost taxpayers more.
Keeping clinics open in remote and rural areas
Rural regions are particularly affected by challenges in accessing healthcare, where residents have far fewer options for care. Many clinics and hospitals are having trouble hiring new staff to make up for departures, which has led to some facilities closing entirely. Making it simpler for clinics to opt out of public healthcare can help ensure that clinics can remain open and continue to offer services to local residents, particularly in parts of the country that are more remote.
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Disagree
Here are some reasons why people might argue that we shouldn’t allow for more privatization in Canadian healthcare systems.
It will make staffing issues worse
Public healthcare employees who have left their jobs have reported burnout as a major reason for their departure, with many choosing to work in private facilities for a better work-life balance. Allowing private companies to supply staff for struggling hospitals makes the problems worse over time, by creating more healthcare jobs in the private sector, and creating more opportunities for companies to poach staff from public hospitals and clinics.
Lack of evidence for success
Opponents have argued that privatization could decrease the quality of healthcare because private companies tend to prioritize profit over care. Studies from the United Kingdom, which has both a public healthcare system similar to Canada’s and over a hundred private hospitals, have shown that private healthcare is linked to increased rates of preventable deaths, and that there is a lack of evidence to show it reduces wait times in the long run.
It’s expensive
Private companies delivering health care may choose to charge taxpayers very high rates. A study of privatized healthcare costs in Québec shows that the price tag for many procedures more than doubles from public to private settings. This could result in higher taxes or reduced services elsewhere.
It creates a two-tier system
Opponents argue that while the province overpays for its healthcare by giving taxpayer money to private companies, the quality of care in our public healthcare system continues to decrease. Private clinics draw staff and residents away from public institutions, which makes the problems that public institutions face even worse. The result could be a two-tier system: one where wealthy people can pay to get faster access to quality healthcare, and everyone else has to deal with a lesser, weakened public system.
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