Services paid for directly by patients, outside provincial health insurance plans is not the solution to Canada's health care problems. Two researchers from the University of Manitoba in Winnipeg explore the consequences of private health care within the public system in Canada, using examples from their studies of cataract surgery.
In Canada, the term "private health care" is generally understood to describe care that is paid for by private sources: private insurance plans, employer-provided health plans, deductibles, and other out-of-pocket expenses. Source of payment is separate issue from ownership of a practice; a physician in private practice may receive all of her or ohis income from the public health insurance program. The vast majority of physicians practice entirely within the public sector, that is, all of the care they provide is paid for by public sources. Very few physicians practice entirely in the private sector; some practice both publicly and privately. Private clinics generally offer procedures that are not covered by the public purse. Some types of cosmetic surgery, such as breast implants or tattoo removal, fall into this category. Sometimes the procedure is covered publicly but the overhead expenses at the private clinic must be paid for by the patient. Despite the extra expense, patients may--and some do--opt for private health care because they perceive waiting times in the public system to be unacceptably long.
The authors describe waiting times for cataract surgery. The Consumers' Association conducted a telephone survey of ophthalmologists' offices and clinics in five Alberta cities. They asked how long it would take to get an appointment with the ophthalmologist and--if cataract surgery were recommended--how long the wait would be for surgery. The initial appointment to see the specialist was available within three to four weeks. But there were intriguing differences in the waiting times for surgery. For surgeons who operated only in public hospitals, the prospective "patients" were told that they would have to wait from two to eight weeks for cataract surgery; the average was six weeks. In contrast, the waiting times for surgery at private clinics were from one day to four weeks. However, the waiting times were lengthy--up to a year--for surgery performed in public hospitals by surgeons who operated in both public and private sector settings. Patients in Alberta whose doctors operated both privately and publicly would get the impression that the wait to have surgery in a public hospital was far longer than the wait for surgery in a private clinic. What these patients would not know is that if they had gone to a surgeon who operated only in the public hospital, the waiting time would have been far shorter. Thus, patients' perceptions of longer waiting times in the public sector would be influenced by which physicians they consulted.
The study also assessed who used private services and the costs associated with that care. They concluded as follows: "Is private sector growth caused by rationing or cutbacks in the public sector?" Evidently not. Do private clinics provide faster service? Sometimes, but the differences may depend on the individual physicians type of practice. Are only the wealthy being channeled to the private sector? No. Fully one-third of Winnipeggers who paid for their cataract surgery in 1993-1994 were from the city's low-income neighborhoods.
Do private clinics increase costs? Yes, for the patients who pay for the service, the cost is significant, approximately $1000. In the case of cataract surgery, the benefits of a two-tiered system [public and private] are far from proven.
For Further Information:
CONTACT: Carolyn DeCoster, RN, MBA
Department of Community Health Sciences
Faculty of Medicine, University of Manitoba
tel. 204-789-3666; fax204-774-4290;
e-mail: firstname.lastname@example.org Other author: Marni D. Brownell, PhD
NOTE: This memo to reporters is from the journal staff and is not an official release of the US Public Health Service; nor does it reflect USPHS policy.