Dalhousie University professor says private health-care options becoming more available

We often hear the debate about private versus public health care as the Nova Scotia system stresses under pressure. 

But Katherine Fierlbeck, a professor and McCulloch research chair at Dalhousie University, says the debate “needs a reality check.” 

So Fierlbeck took it upon herself to look at different private health-care models, how they vary from province to province and what the future of private health care may look like. 

Fierlbeck’s analysis was published Thursday in her latest research paper for the C.D. Howe Institute, titled The Scope and Nature of Private Healthcare in Canada. 

“It is crucial that we understand the topography of health care in this country,” Fierlbeck said.

“Increasing demand is putting intense pressure on the health-care system. This demand, along with new health-care delivery models, means that more people — even those firmly committed to public health care — are increasingly able, or even obliged, to look for care outside of the public system.” 

Fierlbeck highlights at the beginning of her paper that there is no “simple model” of private health care, as it exists in many different forms. 

“It varies with regard to the way health care is provided, the way it is funded and the way it is regulated,” Fierlbeck writes in her report. 

Examples of private health care are private surgical companies, medical specialists who contract their services to medical facilities or universities and independent private health clinics. 

Fierlbeck noted some privately provided services, such as hip replacement surgery, are funded publicly and while it is controversial, “it is not uncommon within Canada.” 

But why is this? 

Fierlbeck looked at people who pay for services that a general practitioner would typically provide.

“If people have immediate access to their GPs, without any upfront payment, they will of course have little incentive to seek the services of nurses or nurse practitioners, potentially at a much higher out-of-pocket cost,” she said.

“But if patients cannot access their GP in a timely manner, or if they have no GP at all, then immediate access to a nurse practitioner, even at a higher cost, becomes very attractive.” 

And with virtual care on the rise in Canada, many private virtual health providers have entered into contracts with provincial governments. 

For example, the Nova Scotia government is covering the costs of Maple sessions for those without a primary care provider. Otherwise, those with a primary care provider must cover the cost after their first two sessions.

“This demand, along with new health-care delivery models, means that more people — even those firmly committed to public health care — are increasingly able, or even obliged, to look for care outside of the public system.” 

– Katherine Fierlbeck

On the flip side, Fierlbeck said the expanded scope of some health-care providers, such as pharmacists and nurse practitioners in Nova Scotia, is viewed as increasing public access to health-care services.

“But these health-care providers do not always face the same legislated restrictions against working in the private sector that physicians do,” she said. 

In Nova Scotia, physicians can work outside the public system but are not allowed to charge above the public fee schedule. Nova Scotia currently doesn’t have any physicians working outside the public system. 

As provinces and territories feel the demand pressures on their health-care systems, Fierlbeck said it’s resulting in private health care becoming more available and more attractive. 

“Canada’s unique federal system means that fears of privatization can also be useful in leveraging more funding from Ottawa,” she said. 

“Rather paradoxically, provinces have an incentive not to contain the growth of private health care within their borders in order to make the case that more public funding is necessary.” 

However, she cautioned that Ottawa could demand provinces “cleave to the spirit” of the Canada Health Act. 

But Fierlbeck says “the legal intricacies that exist in the nexus of provincial legislation and the CHA will always remain secondary to the wider political opposition to, or support for, private health care.”