The battle over a private surgery centre in Vancouver could have big implications for physicians choosing whether to practice in the public or private system.
That’s according to Michael Law, a professor at the University of B.C.’s school of population and public health. Law partnered with University of Victoria researchers to look at how Quebec doctors left the public health care system after two policy changes. The first was a 2005 Supreme Court of Canada ruling on Chaoulli v. Quebec that found the province’s banning of private insurance for publicly insured medical services violated the Quebec Charter of Human Rights and Freedoms. The second was a regulatory clampdown forbidding double billing that was implemented by Quebec’s government in 2017.
In B.C., the issue of double billing is likely headed to the province’s top court, after the Cambie Surgery Centre lost a bid to double-bill patients at the B.C. Supreme Court. Double billing is when a health-care provide bills the patient and the government for the service. Owner Dr. Brian Day had claimed the B.C. government was denying patients the right to timely care by not letting them go private.
Day lost the ruling, but will likely appeal the decision.
Law said the decision of that ruling could have longstanding implications for B.C.
“British Columbia does not allow physicians to practice in both the public sector and private sector, you either have to be in or out,” he said. “One of the sections in the Medicare Act that was under challenge was that section.”
Law said that his team looked at Quebec doctors because unlike B.C., that province publishes a monthly list of physicians who have opted out of the public sector. In B.C. he said, while private surgery clinics are popular, it’s impossible to tell how many doctors are leaving the public system.
In Quebec, the number of doctors leaving is significant. For specialists, researchers found 23 doctors opted out in 1994, compared to 150 in 2019 – a 552 per cent increase.
For family doctors, the rise in those leaving the public system was even higher. In 1994, nine family doctors had opted out of the public system. By 2019, that number had grown to 347 – a spike of 3,755 per cent. If that trend is mirrored in B.C., where family doctors are already often lacking, the province could have a problem on its hands.
But Law said that regardless of the results of the Cambie Surgery Centre’s appeal, there are steps the province can take to make sure doctors stay in the public system.
“Don’t give people a reason to want to go to the private sector,” he said. “You need to maintain a level of quality and accessibility in the public sector that doesn’t make people feel the necessity of going private and paying to get things done.”
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