Transcript
Speaker: I'm Jane Williams. This is the Red Eye Podcast, produced at the studios of Vancouver Cooperative Radio. In our episode today, I talk with Andrew Longhurst about his report on the concerning rise of corporate medicine in British Columbia. Private surgeries and medical imaging are big business in BC. As of June this year, there were 45 private surgical clinics operating in the province.
Speaker: A new report says that government policies have created a market for these clinics by signing contracts with them to deliver publicly funded services worth almost $400 million over six years. Health policy researcher Andrew Longhurst says the provincial government needs to stop subsidizing for -profit clinics and wean BC off its growing reliance on corporate healthcare delivery.
Speaker: Andrew Longhurst joins me today. Hello, Andrew. Hello. What are the kinds of services that the BC government is contracting private clinics to perform?
Speaker: So we tend to see low acuity surgeries. These tend to be orthopedics. They tend to be cataract surgeries, hernia repairs. So these are procedures that don't require any longer than a day stay and often can be performed in a couple hours or less. And we also see contracting of diagnostic medical imaging.
Speaker: So these could be CT scans and x -rays and to some extent, MRIs. So it tends to be a mix of those procedures. And again, on the surgical side, these are low acuity procedures that don't require overnight stays for patients.
Speaker: So a private surgical clinic then gets public funding to perform, let's say, a hip replacement, but they also require the patient to pay. So the clinic is essentially getting paid twice for that surgery. Is that right?
Speaker: Not quite. So this report documents the fact that there has been nearly $400 million over the last six years flowing to for -profit surgical and imaging clinics. And what it also uncovered is that at least two of these contracted clinics, so in receipt of public funding for publicly funded surgeries where the patient doesn't have to pay, at least two clinics have been audited by the BC government
Speaker: and were found to be engaging in unlawful extra billing. So not likely the same contracted procedure, but on the side that these clinics are also engaged in private pay surgeries and engaging in unlawful billing practices that are contrary to the Canada Health Act and to BC's Medicare protection. So it's not the surgeries and the medical imaging that the BC government has contracted them to do, but it's other stuff.
Speaker: So currently in BC, our legislation provincially and also federally prohibits extra billing, unlawful extra billing, where a patient is charged for medically necessary healthcare and in many cases allows a wealthier patient to be able to receive that care faster. Now for surgical clinics, unlawful extra billing is prohibited under our provincial legislation and under the Canada Health Act.
Speaker: For medical imaging, it is prohibited under the Canada Health Act, but BC's legislation doesn't in fact prohibit extra billing. So BC is not in compliance with the Federal Canada Health Act. And that's one of the concerns that's raised by the report is that we have quite a significant industry of private medical imaging clinics.
Speaker: which continue to benefit from the ability to charge patients privately through unlawful extra billing. And at the same time, they are in receipt of public funds through public contracts with health authorities. So I think the real issue here is that we have the use of public dollars working at cross purpose with our efforts to rein in unlawful extra billing in BC.
Speaker: And that's one of the concerns here is, and then specifically through Freedom of Information requests, this research uncovered that at least two private surgical clinics were in fact audited and then have continued to receive public payments from health authorities for contracted services. And those two clinics were False Creek Surgical Centre in Vancouver and Kamloops Surgical Centre.
Speaker: So how does the BC government get around that when it awards contracts to private clinics? Well, we know that in recent years, the BC government has said that it is contracting with clinics through regional health authorities and that those clinics and the physicians and surgeons working in them must comply with the Canada Health Act and the BC Medicare Protection Act.
Speaker: So that has been the government's position in terms of its use of outsourcing that these clinics are compliant with the Canada Health Act. But the problem is that still in BC, our provincial legislation is not in compliance with the federal Canada Health Act.
Speaker: And then as the report also uncovers, while the stated aim of government may be to only outsource to clinics that are compliant with the Canada Health Act and our provincial legislation, I think what this report shows is that it's not so clear cut. And in fact, we have seen clinics that have engaged in unlawful extra billing
Speaker: and have continued to receive public dollars. So in the case of False Creek Surgical Center, the health authority did actually abruptly end its contract with the clinic over extra billing after an FOI request revealed that the corporate representative from the company had two meetings with the deputy health minister and said to the effect,
Speaker: You know, I hope we can work through these differences, but our business model really depends on outsourcing. Subsequent to those meetings, False Creek Surgical Center later was renamed False Creek Healthcare Center under new ownership. It received further public contract.
Speaker: So in that case, I think what's troubling is that even after engaging on unlawful activity, that clinic then had its public contract renewed. So I think it just it's unsettling in the sense that we have a track record of a clinic engaging in this unlawful activity and then receiving a public contract
Speaker: in the case of Kamloops Surgical Center, actually during the audit period and following the audit period, which uncovered evidence of unlawful extra billing, that clinic continued to receive public payments from Interior Health Authority. So it really raises pretty significant concerns about why these clinics are receiving public funds for publicly contracted surgeries.
Speaker: And yet we see government itself has been auditing them and finding them to be engaged in unlawful activity. So I'm not sure what other industries we would allow this kind of activity to continue and then reward them with public dollars. So that really, I think, centers around the concerns in terms of what's happening and what's been happening in this industry.
Speaker: And then on the medical imaging side, these clinics are not audited because we still to this day don't have a ban on unlawful extra billing even though the Canada Health Act prohibits it and the federal government has long been urging the BC government
Speaker: to bring its provincial legislation into compliance. And what this means is that the amount of extra billing that's happening in BC is calculated by the federal government and the province and then BC loses out on federal funding on a dollar for dollar basis based on the amount of unlawful extra billing.
Speaker: So British Columbians lose out on federal dollars to fund public health care by allowing this unlawful extra billing to continue. And that's been going on for many years now in BC, and in fact, BC has had the worst track record among the provinces in unlawful extra billing.
Speaker: So there are a lot of issues, and I think it just raises real concerns about why we are entrenching an industry that continues to engage in two -tier healthcare. Well, let me ask you that question. Why are we doing that? Well, I think as the Freedom of Information request revealed in the case of False Creek Surgical Center, it really reflects the power of corporate medicine or corporate healthcare providers in our public healthcare system.
Speaker: The fact that you can go and meet with the Deputy Health Minister and say that our business model depends on public dollars, and then even after there's evidence of unlawful extra billing, contracts are re -awarded, I think really speaks to the corporate influence and the fact that as we entrench these corporations in our publicly funded healthcare system,
Speaker: They increase their influence and their power and they engage in lobbying and so not unlike other industries, but I think particularly concerning when it comes to healthcare and the ample evidence we have about the fact that not for profit and publicly delivered healthcare.
Speaker: is going to deliver better outcomes. It's really concerning that we see the entrenchment of this for -profit industry in our healthcare system at a time when I think we need to be moving in the opposite direction, which is strengthening and improving publicly funded and not -for -profit delivered healthcare. Are there signs that the BC government is starting to move in that direction?
Speaker: Well there are and so that's I think really a positive development is over the last number of years under the current BC NDP government there has been a concerted effort to increase BC's capacity especially for MRI scans.
Speaker: But again, it doesn't mean that we can't take these issues seriously that the report identifies. And the fact that we continue to see significant public funds flowing to for -profit clinics and more so the issue of private billing or unlawful extra billing that continues
Speaker: in the private medical imaging sector in BC. And that's a big concern because the BC government needs to bring its legislation into alignment with the Federal Canada Health Act. What are the costs to the public health care system of outsourcing this kind of work? And I'm thinking here of the not the financial costs, but other costs to the system.
Speaker: Well, that's a great question. So we have a large body of evidence that shows inferior outcomes in for -profit delivered healthcare. So we have a large body of evidence when it comes to for -profit seniors care. And this is, you know, before and during the pandemic.
Speaker: And much of that has to do with lower staffing levels and staffing ratios around having not the appropriate mix of personnel to provide better outcomes and provide the supports. But specifically on the surgical side, we had a study that was completed
Speaker: Now, a number of years ago, it looked at the higher cost, nearly a four -fold increase of outsourcing to private surgical clinics than completing those surgeries in the public system. And it also showed worse return to work outcomes. So, it was looking specifically at the use of workers' compensation funds
Speaker: for injured workers who needed knee surgeries. And what that study showed is that it was actually more expensive to contract or outsource to private clinics, and the outcomes were inferior to those when surgeries were delivered in the public system.
Speaker: And there's also other evidence around these issues and it's not just limited to BC or Canada, but we had a large study on outsourcing to private for -profit companies in England, which has really embraced outsourcing to a much larger extent than Canada.
Speaker: And it looked at the relationship between increased outsourcing of publicly funded healthcare to for -profit corporations and showed a relationship to increased mortality. And so those authors of that recent study concluded that if we had not seen that type of outsourcing, that England would have seen fewer preventable deaths.
Speaker: So I think this research really needs to be taken seriously within a context of the need to improve quality of care, the need to be more cost efficient with our public dollars, and I think overall what is troubling is we're seeing a ramp up in BC of the use of
Speaker: private surgical facilities. So over the six year study period in this report, public dollars flowing to these for -profit surgical centers increased 357%. Now on the use of contracted for -profit imaging clinics, that amount has actually started to taper off.
Speaker: in recent years and that's really in large part due to the fact that the BC government has made that a real focus to improve and increase public sector diagnostic imaging capacity so that's good news but overall the provinces is still very much reliant and yet that is not aligned with the research evidence in terms of improving outcomes
Speaker: cost effectiveness of care. And I think the big one that we're facing right now is the fact that we see when we ramp up private for -profit healthcare delivery, we are leading to staffing shortages in our public hospitals. And that's very much the case right now. The more that we increase for -profit healthcare delivery,
Speaker: the more that we are going to rob our public health care system of the staffing that we desperately need. And that can't come at a worse time because it is really a dire situation in terms of staffing shortages in our public hospitals.
Speaker: I think that's often the piece that people miss is that it's actually the same people. You don't double the number of healthcare workers if you suddenly start funding the private sector. You're actually using the same people. That's right. I think the big story right now is the fact that we have such severe staffing shortages. I don't think most people understand how severe it has become.
Speaker: And so continuing to entrench for -profit healthcare delivery is undermining our efforts in the public system to try to strengthen our ability to staff our hospitals. Not a day goes by that we don't hear about emergency departments or healthcare services being either shuttered or so severely understaffed that they can't deliver timely care.
Speaker: And that's what is also giving rise to calls for privatized and two -tier healthcare. If we continue to see our public healthcare system deteriorate to the point where people lose trust in it, that is giving rise to calls for basically a complete dismantling of publicly funded healthcare in this country.
Speaker: And that would lead us to much, much worse outcomes and a lack of access except to those who can afford it. So, you know, these issues are all connected, but we have to follow the evidence and improve the system. And that needs to start with looking to proven models of team -based care delivery, especially in surgeries.
Speaker: where we make the most effective use of our healthcare human resources and being able to use these models that have shown their ability to reduce wait times and also better support patients. So, for example, we know a lot of patients are waiting on a surgeon's wait list for a consultation, but in the area of orthopedics, we often know that upwards of 50 % don't actually go on to surgery.
Speaker: So having better access to, for example, a physiotherapist who can triage and support a patient who doesn't need surgery is really going to go a long way in improving access to surgery for those who urgently need it and freeing the surgeon's time to consult with those who need to have surgery urgently. Well, thanks so much for speaking with me today, Andrew. My pleasure. Thanks so much for your interest in the story.
Speaker: I've been speaking with Andrew Longhurst. He's a PhD candidate and health policy researcher in the Department of Geography at Simon Fraser University. He's also a research associate with the Canadian Centre for Policy Alternatives BC office. His recent report is titled The Concerning Rise of Corporate Medicine, and it's available at policy alternatives .ca.
Speaker: The Red Eye podcast is produced at the studios of Vancouver Co -op Radio. You can support us by supporting Co -op Radio. Go to coopradio .org and click on the donate button. Independent media relies on the support of people like you.
