Private health care increases mortality rates, experts concerned: study

Experts are concerned about the direction Quebec is taking by increasingly turning to the private sector to provide health care to the population (care that is often publicly funded).

A new study by Institute for Research and Socioeconomic Information (IRIS) and the Canadian Centre for Policy Alternatives shows that countries with a greater private presence in health care have higher mortality rates and lower life expectancy.

The study published on Thursday, analyzed the health-care systems of 25 member countries of the Organization for Economic Cooperation and Development (OECD). The results conclude that countries that allow more room for private for-profit entities in the health-care sector perform worse on seven mortality indicators.

Anne Plourde, IRIS researcher and author of the study, said Canada had “mediocre” results in five out of those seven indicators selected for analysis.

“Even on certain indicators, such as infant mortality and maternal mortality, Canada really stands out with very poor results,” explains Plourde.

The report distinguishes between private financing, i.e., where the money comes from (if it comes from people’s pockets or insurers, it is private; if it comes from the government, it is public), and private provision, i.e., health-care providers such as hospitals or private for-profit institutions.

Canada has a mixed model. It is in the group of countries with high private funding, but with barely 1% of its hospitals being private, so it has low private provision.

Canada places significant emphasis on private insurance and costs charged directly to patients in certain sectors, such as medication, physical therapy, and mental health, explains Plourde.

“Private spending accounts for 27 per cent of total health-care expenditures in Canada,” Plourde said. “If we choose to further privatize services in Canada, it will be even more detrimental to the health of the population.”

Privatization of services

Mylaine Breton, Canada Research Chair in clinical governance of front-line services and full professor in the Department of Community Health Sciences at the University of Sherbrooke, is particularly concerned about the rise of the private sector in telemedicine. She notes that there is currently an expansion of virtual consultations, a consequence of the difficulty of accessing health services.

“A recent significant breach is telemedicine and teleconsultations. Because here, doctors are allowed to work in both the private and public sectors, which is not normally possible,” explains Breton. As a result, patients pay out of pocket for a service that should be covered by the public health-care system. “For me, that’s dangerous,” she says.

Plourde agrees with Breton.

“Since the start of the pandemic, there has also been a growing presence of for-profit, private telemedicine platforms, where doctors collaborate with other health-care professionals,” Plourde says. “These are paid platforms, and that, too, poses a significant problem.”

Not just the private sector’s fault

Although privatization undoubtedly has an impact on certain mortality indicators, social determinants such as education and housing are even more important, says Breton.

“One of the determinants of health is the health-care system, but that only accounts for 20 per cent of mortality. So 80 per cent of mortality is explained by factors outside the health-care system. We may focus on the 20 per cent of the health-care system to explain it, but the major [drivers] are much broader,” she says. In the same city, for example Montreal, there are mortality differences between wealthy and disadvantaged neighborhoods.

Régis Blais, full professor and head of graduate programs in health services administration at the University of Montreal’s School of Public Health (ESPUM), also points out that other variables, such as available resources, including the number of doctors and nurses per 1,000 inhabitants, were not taken into account. “The quality of care is not evaluated either. Do two countries with the same level of privatization have comparable quality?” he asks.

Privatization of surgeries

To reduce surgery waiting lists, the Legault government has decided to shift toward the private sector. This situation could lead to long-term problems, according to the experts consulted.

Plourde raises concerns about surgeries in Quebec being increasingly done at private facilities.

“According to the latest estimates, 19 per cent of surgeries in Quebec are now performed in for-profit private clinics,” she says. “A few years ago, no surgery was outsourced to the private sector, so there has really been a great deal of privatization in that respect.”

Blais acknowledges that surgery waiting lists are long, which is why the government wants to turn to the private sector. However, he points out that private clinics that perform surgery are starting to resemble private hospitals and private health-care providers.

“This means doctors working in private companies, private surgical clinics where there is equipment to perform hip replacements and many other surgeries that are performed in hospitals,” he summarizes. So, the funding is public, but the service is private. The IRIS report shows that when you combine the two, mortality rates are generally worse.

“We’re promised that if we use the private sector more, it will improve access to services. That’s the main reason given by governments in different provinces to justify increased privatization of services,” says Plourde.

“Other studies have been published that question this claim by the private sector that it improves access to services even when they are paid for with public funds. But on the other hand, what we see in the study we are publishing today is that even if it did improve access to services, the finding is that there is a link between more private sector involvement in health care and higher mortality rates. That is very concerning,” argues the IRIS researcher.

Blais says that in the long term, this is not a viable solution. “In Quebec in particular, [surgeons] say that we don’t have enough operating time, we can’t operate as much as we want in the public system because there is a shortage of support staff, particularly respiratory therapists and nurses. This means that these doctors and surgeons, who want to practice their profession, are leaving for the private sector, where they can also recruit staff to assist them in surgeries. So, if the private sector is attractive, […] then these professionals, these doctors and surgeons, are not available in the public sector,” he explains.

Breton is also discouraged by the many operating rooms that are underutilized due to a lack of staff. She would like the government to “think differently,” not with private firms, but by focusing on better collaboration with university researchers in Quebec. “I find it hard to imagine how we can’t find models for experimentation with the same funding,” she says.

To stem the exodus of doctors to the private sector, it should be noted that Health Minister Christian Dubé passed Bill 83 last spring, which, among other things, requires all doctors to obtain authorization from Santé Québec if they want to leave the public system to practice in the private sector.

– With files from La Presse Canadienne