The Vancouver Sun reports this morning that after meeting with Minister of Health George Abbot, the False Creek Surgical Centre's new Urgent Care Centre will not bill patients directly for medically necessary procedures, but will abide by the Canada Health Act and Provincial medical billing regulations. This after Abbot and the BC Medical Services Commission promised to audit the clinic and prosecute any violation s of the Canada Health Act. Bravo, the province did the right thing. But was this whole little even staged?
If you really think about it, this really serves the agenda of a lot of people who would like to see more privatization of health care in Canada. Federal Health Minister Tony Clement got to wring his hands and say the Feds have no authority to shut down the clinic (and no desire either). This of course is true, but they do have the authority to withhold health and social transfers to the province if the the province allows the clinic to operate. The Campbell government got to demonstrate their commitment to the public payer principle of the Canada Health Act by forcing the clinic to comply. But they also got a chance to float a trial balloon to measure the public response to the opening of a private clinic. Apparently, if you glean from the press coverage, three patient showed up and got to pass on the message that they would be willing to pay for prompt medical service. This message was echoed in the Vancouver Sun's letter of the day (sorry only in the paper version) in which a Mr. Jim Gilmore said:
"I am one of thousand of British Columbians languishing on waiting lists, and I think the opening of the clinic is good news. While I might not exercize my choice to use the clinic, many others will, and it does not take a math professor to figure out that this will ease the pressure on the public system."Did you notice how Mr. Gilmore managed to get all the key talking points in? Consumer choice, waiting lists, relieving pressure on the public system - sounds awefully similar to Mr. Klein's trial balloon exercize and the key messaging around it in Alberta last year.
Let me first get to Mr. Gilmore's argument. It doesn't take an economics professor to figure out that the method in which a provider bills and is remunerated for services in no way impacts the supply/demand for medical services. What makes the business model (as initally advertized) illegal under the Canada Health Act is not private ownership, but direct billing to patients rather than through BC Medical Services Plan. The clinic should be free to operate as long as all medically necessary procedures are billed through MSP.
If a provider is permitted to "double dip" i.e. to provide services for both MSP and private paying patients it creates a perverse incentive for that provider to keep wait lists as long as possible because this enhances the value of the privately billed practive. If provider only provides privately billed services, it will serve only a very small number of people who can afford private medical insurance or fees. Neither approach increases the capacity of the system to handle more patients nor do they allocate services according to urgency of the need. Unless the public becomes better informed on the issues we are going to slowly creep towards a two tier system that does not serve the public interest. It will be justified as a solution to wait lists, but in fact it will make wait lists worse. This little trial balloon is just a step in measuring the public's sentiment towards something that (it appears) few really understand.