The private sector in health care: panacea or bad idea?
The private sector in health care: panacea or bad idea?
The private sector’s role in health care was on everyone’s lips during the election campaign, but given the widely diverging opinions, there was no clear understanding of how that might be interpreted. François Legault said he wanted to accelerate the “migration” of primary care services to family medicine groups (GMFs) and give private clinics more latitude in specialized care. Dominique Anglade wanted a major push to clear the surgery backlog, through agreements with the private sector. Eric Duhaime bluntly questioned the basic principle of keeping public and private health care separate. And Gabriel Nadeau-Dubois tersely commented that if private health care worked, we’d know about it.
So what are we to make of the government’s intended strategy for this term of office, especially in the context of rolling out its notorious Plan santé to implement changes in health care? Anne Plourde, author and researcher at the Institut de recherche et d’informations socioéconomiques (IRIS), helped our General Council delegates sort out fact from fiction. Here are the highlights of her presentation.
Private involvement in health and social services: not so new
With a majority of political figures now unabashedly calling for greater reliance on the private sector in health and social services, this strategy may seem innovative and effective. But private funding for health care in Québec has increased by more than 50% since the late 1970s.1 In long-term homecare services, for instance, 85% of the hours of service provided are from the private sector. The use of employment agencies and private seniors’ residences account for many of those homecare services.2
The private sector is already well-entrenched in primary care, with family medicine groups (GMFs); in housing, with private CHSLDs and other intermediate resources; and in professional services. And the results, as we know, are nowhere near up to par.3
Private sector = more efficient health and social services?
The private sector is often touted as being more productive than the public sector, bogged down in bureaucracy. This claim is not borne out in family medicine groups (GMFs), however, 75% of which are private. Created in the early 2000s to relieve overcrowding in emergency rooms and improve access to family doctors and psychosocial services, this clinic model has enjoyed unswerving financial and organizational support from governments for the past 20 years. But the family medicine groups have not achieved any of their objectives. For example, in terms of access to family doctors, the patient-doctor ratio in these clinics has remained fairly stable or has declined4 since these data were collected!
Aren’t private health and social services less costly?
In the case of private employment agencies, actual spending costs point to a very different conclusion. An analysis of expenditures for independent workers (i.e., from employment agencies) in the homecare sector shows that “the immediate cost reductions promised by privatization of services tend to diminish in the long term, or disappear altogether, as public services become increasingly dependent on private companies.” That was the case even before the pandemic, and in just 4 years, spending increased by 150%, while the number of hours of service provided increased by only 75%.5
What about the private sector’s role in reducing waiting lists?
Studies on the subject clearly show that the opposite is true: the more the private sector is involved in health care, the longer the waiting lists in the public sector. The reason is simple: professional resources move from one sector to the other, but the number of professionals doesn’t magically increase. Once these resources are absorbed into the private sector, many people have to wait even longer for physiotherapy, psychotherapy, speech therapy or other services because of staffing shortages or lack of access to private insurance. It is estimated that local community service centres (CLSCs) have lost more than 700,000 hours of social service consultations and nearly 60,000 hours of psychological consultations… to family medicine groups (GMFs).6
The more the private sector is involved in health care, the longer the waiting lists in the public sector. The reason is simple: professional resources move from one sector to the other, but the number of professionals doesn’t magically increase.
Can’t the private sector at least help relieve the pressure on emergency rooms until we find a better solution?
Once again, an examination of family medicine groups (GMFs) indicates that the private sector doesn’t keep its promises. Indeed, more than half of the GMF networks — which receive additional funding to act as “mini-emergency rooms” — do not meet the quotas required by the Ministry of Health and Social Services for appointments offered to “orphaned” patients (i.e., those without a family doctor). What’s worse, an access-to-information request revealed that one family medicine group out of six had concluded an agreement with a hospital’s emergency services so that the latter would cover part of the GMF’s business hours.7 So now emergency departments are relieving pressure on family medicine groups, adding insult to injury.
What can we do?
A number of Anne Plourde’s conclusions align with our APTS positions. In her work, she stresses the need to oppose any expansion of the private sector’s role in the health and social services system. She hammers home the importance of making public primary-care services a genuine priority, particularly by reinvesting in CLSCs and enhancing their role. Plourde adds that CLSCs must be managed democratically and locally, taking into account the contribution of health and social services professionals and technicians — and continue to be critical of undue concentration of power in the hands of doctors.
And while Minister Dubé’s Plan santé seems to be heading in the opposite direction, it at least gives us an opportunity as citizens, professionals, technicians, researchers, unions and other organizations, to collectively expose its many blind spots.
1 Hébert, Guillaume, IRIS, La progression du secteur privé en santé au Québec, Montréal, Mars 2022, 5pp.
2 Plourde, Anne, IRIS, Les agences de placements comme vecteurs centraux de la privatisation des services de soutien à domicile, Montréal, 19 janvier 2022, 24 pp.
3 Hébert, Guillaume, IRIS, Les rouages du secteur privé en santé, Montréal, Avril 2022, 4pp.
4 PLOURDE, Anne, IRIS, Bilan des groupes de médecine de famille après 20 ans d’existence – un modèle à revoir en profondeur, Montréal, Québec, 28 mai 2022, 26 pp.
5 Plourde, Anne, IRIS, Les agences de placements comme vecteurs centraux de la privatisation des services de soutien à domicile, Montréal, 19 janvier 2022, 24 pp.
6 PLOURDE, Anne, IRIS, Bilan des groupes de médecine de famille après 20 ans d’existence – un modèle à revoir en profondeur, Montréal, Québec, 28 mai 2022, 26 pp.