Canada's provinces have experimented with various forms of private, for-profit health care. In doing so, they have learned some important lessons: expected cost savings do not always bear fruit, regulation can be difficult and turning medicare over to commercial interests is not a panacea.
British Columbia: All priviate, all the time
Few, if any, facilities better illustrate the growth of private health care in Canada than the False Creek Healthcare Centre in Vancouver.
What began as a modest, private surgical clinic in 1996 has evolved into a comprehensive operation providing a vast array of procedures.
Besides surgery, the centre offers state of the art diagnostic imaging, an "urgent care centre" promising service akin to hospital emergency rooms, and expensive, all-in-one health packages for families and executives.
President and medical director Mark Godley says the False Creek centre is the first, vertically integrated, private health care facility in Canada.
"Somebody can come in with an undiagnosed health care issue, go through our clinic, then work their way through advanced diagnostics, see specialists and proceed to receiving treatment, all within a very compact time frame."
And the province's Medical Services Plan is billed for none of it.
"That's where we are different from other private surgical clinics," says Dr. Godley. "None of our surgeons has ever billed MSP. We cover their costs, not the public health care system."
Although surgeons used by the centre remain enrolled in MSP for their outside, non-private work, the facility's two, full-time family physicians have opted out of medicare entirely. That allows Dr. Godley's clinic to charge patients up front for access to a GP without coming into conflict with the Canada Health Act.
The centre offers yearly health packages priced as high as $5,000 for a family of four. It currently has 400 patients who have paid for its family health plan.
"What people are paying for is really access. We cater to individuals who don't have time to wait," says Dr. Godley.
Alberta: The cautionary tale
For the past six years, the Health Resources Centre in Calgary derived most of its revenue from a multimillion-dollar contract with the province to perform more than 900 hip, knee and foot surgeries a year.
But the government has terminated its contract with the centre, reigniting a heated debate in the province over the place of private, for-profit medical clinics in the publicly funded health-care system.
On Friday Nov. 12 the clinic will close its doors as part of an out-of-court agreement with the province. Alberta Health Service, which oversees health-care delivery in Alberta, will transfer the centre's orthopedic surgeries to a new publicly-owned medical clinic.
Health Resource's Centre's financial woes began earlier this year when the government began taking steps to terminate its contract. The government injected $2-million into the clinic to keep it operating.
If a private centre can deliver care that's better, faster and cheaper and its covered by public health care dollars, said the centre's medical director Dr. Stephen Miller, it shouldn't matter who delivers it.
"There's nothing holy about a public delivery model," he said. "People don't care where they get their services. They just want good care."
Saskatchewan: The risks of overpaying for medical services
When the Saskatchewan government set out earlier this year to clear up a backlog of patients waiting for surgeries and diagnostic tests, it turned to the private sector.
But the strategy was called into question last month after a labour arbitrator ruled that the Regina health region cannot contract out dental surgery and knee arthroscopy to a private, for-profit clinic past 2013, because, in the long run, it is more cost effective to perform the work in the public system. The matter went to arbitration after a union representing health workers objected to the contract with the private clinic.
Both sides in the dispute claimed partial victory. The union said the arbitrator had restricted the use of profit making clinics in the region. Michael Higgins, vice-president of human resources at the Regina Qu'Appelle Health Region, said the province can continue contracting out selected services for the next three years.
"We're quite pleased," he said. "It gives us three years to get our feet wet and see just how successful this contract can be."
Michael Rachlis, a physician and expert witness for the union, said the ruling highlights the risk of over paying for services and diverting scarce health-care dollars into shareholders' pockets instead of patient care.
As for the private clinic, Omni Surgery Centre, it derives most of its revenue from performing cosmetic surgery and treating patients with workplace injuries.
"The health region is something we're doing almost as a good citizen," said president Rob Mitchelson.
Manitoba: Shooting fish in a barrel