Aug 26, 2022
Non-public surgical procedures and medical imaging are large enterprise in BC. During the last 20 years, this for-profit sector has benefited from elevated outsourcing of publicly funded procedures and illegal affected person extra-billing.
These non-public companies are flourishing partially as a result of the BC authorities has been awarding them thousands and thousands of {dollars} in contracts to offer companies whereas not holding them legally accountable for illegal billing practices which can be prohibited underneath the Canada Well being Act and BC Medicare Safety Act.
Outsourcing refers to when authorities contracts with non-public, for-profit corporations to ship publicly funded companies. Illegal extra-billing happens when clinics cost folks privately for well being care companies already offered within the public system, permitting wealthier sufferers to leap the queue.
In a analysis report printed by the Canadian Centre for Coverage Options BC Workplace and the BC Well being Coalition, I analyzed public monetary paperwork and supplies obtained by way of Freedom of Data requests with the intention to take a detailed have a look at current traits. These supplies revealed:
- Greater than $393 million in public funds was paid to personal surgical and medical imaging clinics over the six-year interval from 2015 to 2020 for contracted procedures.
- Annual funds rose from $47.9 million in 2015 to $75.4 million in 2020—a rise of 57 per cent.
- In the newest years out there (2019 and 2020), funds to personal imaging clinics declined because the provincial authorities elevated public sector capability—a really constructive shift—however funds to personal surgical clinics continued to extend.
- Over the six-year interval, the biggest annual improve (21 per cent) in outsourcing occurred in 2017, the yr following the earlier BC Liberal authorities’s plan to extend surgical privatization.
- False Creek Healthcare Centre, acquired by a Toronto non-public funding agency in 2019, acquired $12.2 million in well being authority contracts between 2015 and 2020 regardless of having been audited by the BC authorities and located to have engaged in illegal extra-billing.
- Kamloops Surgical Centre acquired $15.4 million in well being authority funds between 2015 and 2020, additionally regardless of having been audited and located to have engaged in illegal extra-billing. Inside Well being continued to contract with the clinic throughout and after the interval of illegal extra-billing.
Importantly, the BC authorities has made constructive current strikes to boost entry to MRIs and scale back surgical waitlists in public hospitals. However the numbers present a troubling continued reliance on outsourcing to for-profit clinics, particularly for surgical procedures.
It’s notably disturbing to see substantial well being authority funds going to personal clinics identified to have engaged in extra-billing. As an alternative of tackling illegal extra-billing head on, the province’s technique has been to extend outsourcing to personal surgical clinics however make these contracts topic to compliance with provincial and federal regulation. In different phrases, BC is utilizing one type of privatization (outsourcing, or contracting out) as a ‘carrot’ to curb one other (two-tier well being care the place those that can afford it pay privately).
The numbers present a troubling continued reliance on outsourcing to for-profit clinics, particularly for surgical procedures.
That technique is mirrored in correspondence between the house owners of False Creek Healthcare Centre and the Deputy Minister of Well being, which I obtained by way of a Freedom of Data request. In an electronic mail trade following two conferences, the company consultant expresses his appreciation that the provincial authorities will present “long-term, quantity assured contracts which can allow us to make an knowledgeable choice on the long run sustainability of this enterprise mannequin.”
False Creek Healthcare Centre is among the largest non-public clinics in BC and has continued to obtain public funding regardless of a current BC authorities audit discovering the clinic engaged in illegal extra-billing. And it is usually troubling that Inside Well being continued to move public {dollars} to Kamloops Surgical Centre throughout and after the interval when authorities auditors uncovered illegal extra-billing.
The pandemic has put extraordinary stress on public well being care throughout the nation, as surgical procedures had been canceled en masse to unencumber hospital capability to cope with sufferers affected by extreme instances of COVID-19. One of many methods BC tackled the ensuing backlog in surgical procedures was to extend surgical outsourcing to personal clinics and rising public capability. Whereas this technique was profitable in decreasing wait lists within the brief time period, funneling public {dollars} to for-profit companies contributes to workforce shortages in our public hospitals and likewise comes at a steeper worth—a revenue margin, capital prices (non-public sector capital property that the general public pays for however won’t ever personal) and sometimes larger labour prices (to draw employees from the general public sector) are all the time constructed into the per-unit value charged to governments by non-public clinics.
As an alternative, BC can tackle wait instances extra effectively inside the public well being care system by additional rising public surgical and diagnostic capability (the current acquisition of a number of non-public MRI and surgical clinics by the federal government are constructive steps on this path), scaling up profitable methods like centralized ready lists and pre-screening by groups of well being care professionals and decreasing the necessity for hospital care with extra emphasis on main and community-based care (particularly for seniors).
The provincial authorities has made some vital progress in these areas, however it must put a cease to illegal extra-billing and ramp down its reliance on for-profit clinics over the approaching years.
Postscript
At a press convention on August 24 following the discharge of the CCPA–BC and BC Well being Coalition report, Well being Minister Adrian Dix characterised the report’s findings as “inaccurate” and advised that the evaluation didn’t acknowledge important current investments in public well being care by the provincial authorities.
We hope that a proof of the strategies and sources helps make clear considerations. As defined in footnote 10, the writer analyzed well being authority monetary statements between 2015/16 and 2020/21. Every well being authority should publicly disclose funds every fiscal yr to suppliers valued over $25,000. Monetary paperwork had been retrieved from well being authority web sites, and a dataset of personal surgical and imaging clinics was created. The record of personal clinics was verified towards the record of accredited clinics by the Faculty of Physicians and Surgeons. One other key supply is a Well being Canada annual report (additionally cited), which offered details about illegal extra-billing in BC. This evaluation concerned the extraction of information from over 40 well being authority disclosures.
As effectively, the report attracts on two Freedom of Data (FOI) requests, together with non-public clinic audits performed by the Medical Providers Fee that had not been made out there to the general public. Collectively, these public disclosures and paperwork obtained by FOI revealed that Kamloops Surgical Centre and False Creek Healthcare Centre have acquired well being authority funds, regardless of audits discovering proof of illegal extra-billing. This analysis wouldn’t have been doable utilizing solely publicly out there data. To foster larger transparency, we advocate the proactive disclosure of well being authority contracts with non-public clinics and audits of illegal extra-billing.
As well as, the writer rigorously detailed current public investments, together with the provincial authorities’s current (and laudable) efforts to extend public sector medical imaging capability (see pages 3, 4, 8, 10 of the report) and general well being infrastructure spending (see web page 10). Nonetheless, the important thing conclusions of the report bear repeating:
- Between 2015 and 2020, there was a considerable improve in public funds going to company diagnostic and surgical clinics for contracted procedures.
- Whereas reliance on contracting for diagnostic imaging has declined considerably up to now two years, funds to for-profit surgical clinics—together with these which were discovered to interact in illegal extra-billing—proceed to extend.
- There nonetheless stays no ban in BC on illegal extra-billing in medical imaging clinics, regardless of a dedication from the BC authorities to convey provincial laws into alignment with the Canada Well being Act.
- The above information are troubling given the issues related to for-profit drugs.
- Canadian provinces, together with BC, have tended to concentrate on short-term injections of funding and rising the surgical volumes in hospitals and personal clinics, with extra restricted consideration to a sustained concentrate on structural reforms that enhance the efficiency of the general public system, together with team-based, single-entry fashions.
As non-partisan organizations, the CCPA–BC and BC Well being Coalition welcome the invitation from authorities to debate our analysis findings.
Subjects: Well being care, Privatization, P3s & public companies
