Prognosis for profit
Private medicine gains ground
Tom Blackwell, National Post
J.P. Moczulski for National Post
After eight months of gruelling treatment for colon cancer, it was the last news that Howard Steinberg wanted to hear. Tests indicated that there were two golf ball-sized tumours in his liver: the malignancy had spread, and now he would need another round of chemotherapy or potentially dangerous liver surgery.
That is when Mr. Steinberg took matters into his own hands, paying about $2,300 out of pocket to a little-known private clinic to receive a PET scan, a service that in Ontario, unlike in most other provinces, is still not covered by medicare.
The cutting-edge diagnostic tool indicated the 44-year-old Toronto man was, in fact, cancer-free and needed no more treatment, an assessment later confirmed by other tests.
"It would not have been healthy and could have been fatal," he said about the treatment he avoided. "I'm fortunate that I had the financial means to do this. I suspect that many don't."
The CareImaging LP clinic revealed this week it is expanding its unique, Mississauga, Ont.-based PET scan service to Windsor.
At the same time, British Columbia's new health minister just spoke out in favour of a separate, private tier of health care.
Quebec, meanwhile, is poised to implement a law that would encourage more private surgery clinics.
Opinions about the apparent trend diverge widely, but the notion of for-profit medicine -- so often a political taboo -- seems to be gaining ground in Canada.
"There does seem to be a lot of talk about pushing private clinics and private delivery," said Mike Mc-Bane of the union-backed Canadian Health Coalition.
"It is ironic that at a time when the United States is moving toward public health care, governments in Canada seem to want to go the wrong way."
In the long-running public-private health-care debate in Canada, the public side has made some recent gains. Non-profit hospitals and clinics have started chipping away at the lengthy wait times that fuel the sense of crisis in the system, while Ontario, Manitoba and Alberta actually pulled private clinics into the public fold a couple of years ago.
Yet the idea of harnessing the free market to make the still-troubled system run more efficiently is picking up steam.
Quebec, already the unofficial heartland of private medicine, is expected to soon implement Bill 33, a law that would pave the way for more private surgical clinics, carrying out procedures funded by taxpayers. Mike Murphy, New Brunswick's Health Minister, has said he will consider similar use of private clinics to deliver publicly financed operations and diagnostic tests.
For the second year in a row, the president of the Canadian Medical Association (CMA) -- the country's most powerful doctors' lobby -- is a private-clinic owner and is calling for the private sector to play a greater role.
Dr. Robert Ouellet's influence will fade soon, as an avowed defender of medicare, Ottawa's Dr. Jeffrey Turnbull, takes over the CMA's rotating, 12-month leadership.
But a report issued late last year by the Health Coalition said it found more than 120 for-profit diagnostic and surgical clinics across the country, and 89 possible violations of the federal legislation that governs the medicare system.
For Nadeem Esmail of the conservative Fraser Institute, further incursions by private health care are inevitable.
"Canadians are increasingly coming to realize the limitations of the public health-care system," he said. "There is a demand for privately financed services in Canada, which entrepreneurs have been stepping up and providing."
In B. C., Dr. Brian Day, last year's president of the CMA and owner of the private Cambie Surgery Centre, launched a lawsuit in January with other private clinics that argues it is unconstitutional to bar Canadians' access to private medicine. The province responded with a countersuit that accused the clinics of already charging patients direct fees for medicare-covered services.
And yet, the province's new Health Minister, Kevin Falcon, appeared to contradict his own government's position when he told the Vancouver Sun this week he has no "philosophical objection" to patients buying health care in the private realm. He later claimed he had not been referring to medically necessary services.
Citing the health-care budgets that gobble up more and more of the provinces' thinly stretched budgets, Dr. Day argues that a universal health-care system can only be sustained with help from the private sector. "Medicare will end without reform," he said in an email interview.
Not everyone is convinced private medicine is making any gains. For now it remains a phenomenon chiefly in Quebec and B. C., says Dr. Danielle Martin, a Toronto family physician and head of the group Canadian Doctors for Medicare.
"I think we need to guard against it.... [But] I don't think it's mushrooming all of a sudden."
In fact, the term private health care has a variety of meanings, and there is still little support for the concept of a totally separate private tier of medicine. Most commonly discussed, and less controversial, is the idea of private delivery, where governments pay for-profit clinics to perform certain procedures, in theory with greater efficiency than public facilities.
Mr. Esmail and Dr. Day predict the private sector will increasingly play such a role. Dr. Martin, though, says study after study has shown that such facilities end up costing governments more money, while often managing to charge user fees to patients.
The expanding CareImaging company fills a different, unusual role, offering a service the province has yet to decide whether to insure.
Positron emission tomography (PET) scans use "tracers" -- liquids carrying tiny bits of radioactive material that are injected into patients -- to provide an intimate view of parts of the body. Nuclear-medicine specialists call it the state-of-the-art for diagnosing and tracking change in some, though not all, cancers.
Dr. Jean-Luc Urbain, who practiced in his native Belgium and the United States before settling in London, Ont., said he has never seen as many advanced cancers as he has in Canada, and suspects the lack of PET scan service is to blame. "Ontario has been in total denial," he charges.
Others experts argue that not enough is known about when, exactly, using the expensive tool is most justified.
In the meantime, CareImaging has performed close to 2,000 scans in Ontario. Though it is a for-profit enterprise, no patient is turned away, even if it means doing scans pro-bono, said Ghassan Barazi, the firm's CEO. Ideally, though, he would like to see the province insure the service, and pay his company the same fees it would for the publicly-owned PET scans performed in hospitals.
"If it was covered by [medicare]," he said, "demand would be incredibly high."