Canadian Medical Association

Canadians are deeply concerned that the health care system is no longer meeting their needs.  With the system under significant strain — patients struggling to access care, intermittent emergency department closures, growing surgical backlogs— there have been increasing calls to re-examine how we fund and deliver health care services in Canada. 

In a recent survey conducted by the Angus Reid Institute in partnership with the Canadian Medical Association (CMA), 68% of respondents said they believe health care has worsened over the past decade, up from 42% who said the same in 2015. Nearly 70% of respondents doubted that things will change for the better in the next two years.

With the health care system at a crisis point, the need to listen to and incorporate the voices of patients and the providers who deliver care has never been greater. 

There is consensus that access to care on many levels must be fixed and that the solution is not just throwing more money at a dysfunctional system. We need actual structural change.

We’re seeing patchwork efforts as political leaders grapple with the gaps. To improve retention and recruitment of health care workers, the British Columbia government recently reformed how family physicians are compensated to reflect the increased complexity of primary care work. The Atlantic provinces and Ontario have taken steps to improve physician mobility. Several provinces now allow pharmacists to prescribe medications for common ailments. To date, however, there is no national, coordinated approach to these issues that reflects patient and health care provider input. 

Some provinces are proposing or have already increased the role of private providers to expand access to care without increasing out-of-pocket costs to patients. We’re also seeing more for-profit, privately funded corporations providing services across Canadian jurisdictions. 

What this means for our public health system — long a source of pride for Canadians — remains to be seen.  

Words matter. Being informed matters.
It’s important we’re clear about what we mean when we talk about private care. On the one hand are privately delivered, for-profit alternatives that could result in queue jumping for those who can afford to pay their way to the front of the line — a model we’re already seeing in parts of the country. On the other hand are privately delivered, not-for-profit clinics that are being scaled up in some jurisdictions to help reduce backlogs. It’s important we reflect on and discuss these two realities.

The truth is that Canada’s health systems have long featured a mix of both public and private care delivery. And public health insurance plans – what most of us simply refer to as “public health care” – has always covered a finite list of services provided only in certain settings with certain providers. 

Across the country, the balance of public and private care includes care that is publicly funded and delivered; public health care that is outsourced to private providers; and care that is privately paid for and delivered. 

It’s confusing to many. But looking at funding, as of 2022, governments paid for 72% of all health care. The rest was paid by patients: out of pocket (11%), through private health insurance (15%) or other sources (2%).  

It’s time to talk.

Private care in either form is a sensitive subject – one that many people feel challenges their collective values as Canadians. In the Angus Reid Institute survey from earlier this year, 31% of respondents said that more private care would improve health care, while 44% said it would worsen access to care. The percentage of respondents who are “unsure” how they feel increased in the past year. It’s a topic we can no longer ignore.
This is a complex, nuanced conversation that Canadians and health care providers need to have because change will continue to happen with or without our input as jurisdictions grasp for solutions to increase capacity within the system.

It's within this context that the CMA is launching a national conversation on public and private health care in Canada. The purpose of this conversation is two-fold: to elevate our shared understanding of how care is delivered across Canada and to help shape what happens next. Make no mistake: this will be a challenging, charged conversation. Important conversations often are. However, standing on the sidelines while our health systems continue to deteriorate is simply not an option.

The CMA strongly believes that patients across Canada deserve to receive high-quality health care in a timely fashion, regardless of their ability to pay. That belief has not changed. However, the health care landscape and our shared challenges have. It’s time we have an open and honest conversation with Canadians about the future of the health system. We’re here to listen. Please join us and add your voice. 

Dr. Kathleen Ross is a family physician in Coquitlam and New Westminster, BC, and the new president of the Canadian Medical Association.

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