Paying for privacy is a tough issue for hospitals

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In Canada, we like to think that our healthcare is "free," but we actually have some of the highest out-of-pocket health costs in the developed world – about 30 per cent of health spending, or $63-billion a year.

What medicare – the name given to our loose collection of publicly-funded health insurance plans – covers is "medically necessary" care, an ill-defined term that is generally interpreted as meaning hospital and physician services.

While few would argue that treatments that require hospitalization are not "medically necessary," patients are still billed for little "extras" in hospital.

The most common charge is for the privilege of privacy. In the minds of administrators "medically necessary" care can be provided in ward-style rooms, which commonly have four beds.

If you want a private room (one bed) or semi-private room (two beds), you pay surcharges. These costs vary widely by province and sometimes even by institution.

For example, a semi-private room costs about $45 more in Manitoba, and $200 daily in Ontario. A private room will run you anywhere from $80 daily in Alberta to $300 a day in Ontario.

These are significant amounts but they are rarely discussed.

As reluctant as we are to admit it, there is a class system in our public hospitals. People who are wealthier get semi-private or private accommodation.

That's because they have private health insurance – usually employer-sponsored – and one of the things it covers is room charges. (Private health insurance also covers prescription drugs costs, transport services like ambulances and devices like wheelchairs.)

People who do not have private insurance, like minimum wage workers and seniors, end up on the ward. But, thankfully, there are exceptions.

Generally speaking, men and women do not share hospital rooms so the math can mean patients are bumped to private rooms. Hospitals also try to isolate patients with infectious illnesses like influenza to avoid its spread. In these cases, patients are not charged.

The good news, however, is that as old hospitals get renovated and new hospitals get built, ward-style rooms are disappearing. Private rooms are becoming the norm.

Patients are not being mollycoddled; privacy actually makes for safer health care.

Hospital patients are, by definition, unhealthy and often immune-compromised. One of the biggest dangers in hospitals is infections. And one of the greatest impediments to recovery is lack of sleep due to noisy surroundings.

Hospital-acquired infections sicken some 250,000 patients a year and kill between 8,000 and 12,000 Canadians.

Building hospitals with "one bum per toilet" and otherwise minimizing contact between sick people (as well as basic hygiene measures like handwashing and having adequate cleaning staff) and that allow people to sleep, is a good investment.

But what happens when patients are admitted to hospitals that have only semi-private and private rooms? Should they have to pay?

That debate recently exploded in Quebec, where new "super-hospitals" will have only private rooms.

The Quebec Ministry of Health initially proposed that room charges remain but that they be income-adjusted – meaning only those with higher incomes would pay.

But when that idea was floated, it sparked a fearsome response, the gist of which is that charging any fees for hospital care undermines universal access to health care.

The reality is that there are a lot of government policies that make our universal health system less than universal (chief among them limited access to essential prescription drugs) and hospital room charges are the least of them.

But the fact that we charge patients extra for semi-private and private rooms is a striking example of how our health policies are mired in the past.

Quebec takes in about $60-million a year in room charges. That is a trifling amount on a $30-billion public health budget.

Meanwhile, hospital-acquired infections cost the provincial health system an estimated $180-million in direct health costs.

Regardless of one's views on the place of private payment in public health care, charging patients extra for being in rooms that will help them avoid infections and accelerate healing makes no sense.

The only public policy that is more incoherent is our tacit acceptance of the status quo. We should be rushing, full speed ahead, to make private hospital rooms the norm, and ward-style rooms a bad memory.

André Picard is The Globe's health columnist.