Private Facilities Can Help The Publicly Funded System

Nova Scotia has a single payer health care system. This space completely supports the principal that the best care in that system should go to the sickest people, not the wealthiest. It should not be possible to buy your way to the front of the line.

In a single payer system the only way to control costs is to control supply. So, the number of knee surgeries that get done in a year is determined not by demand but rather by what has been allowed for in the budget. There can be trade-offs with like items, such as hip surgeries, but the overall does not change. As a practical matter the long waiting lists for orthopedic procedures in Nova Scotia were there before the covid pandemic.

Health is by far the largest item in provincial budgets. So a government trying to manage its finances does not plan for more care than what is deemed necessary and affordable. The system is not able to quickly ramp up its capacity. It takes a long time to add doctors, nurses, and other health professionals, and even longer to build new clinics and hospitals.

Into that context Nova Scotia experienced two substantial impacts on the need for health care. The arrival of covid in 2020 dramatically increased demand for intensive care beds and the associated staffing. Equally important, the increased needs for infection control made the rest of the system less efficient, an issue which still lingers, albeit at a reduced level.

Secondly, Nova Scotia’s population started to grow in 2016, slowly at first, and then accelerating — we added 58,000 Nova Scotians in the last two years, a 6% increase. Government had not responded to the earlier signs so efforts to shrink the gap in capacity were seriously overdue.

To make matters worse, other provinces and other countries have been similarly impacted by covid, so it is hard to attract people from other jurisdictions.

As the effectiveness of our system worsened, governments that once worried about the politics of engaging private resources became more philosophical.

When private telehealth provider Maple offered to be a government funded service, the initial response had been negative. More recently, it has been embraced and is a valuable resource for the 140,000 people lacking a primary care provider.

Nova Scotia already had partnerships with private health-care facilities. Scotia Surgery, a private hospital in Dartmouth, performed elective and out-patient surgeries, including uninsured cosmetic procedures. The government bought it. Except for certain dental procedures, it has become a fulltime provider of government-funded health care services.

The government pays for dental and cataract surgeries at private clinics that specialize in the procedures. Collectively these are useful but incomplete responses to the problem.

Suppose that five years ago, a private surgery had been established for hips and knees. The customers would be from out of province. Perhaps New Yorkers looking for a less expensive alternative — the weak Canadian dollar would be a big advantage, as would the cost of the facility. In 2018 new orthopedic surgeons in Canada were having trouble getting work because of the budget restrictions for joint surgeries.

There would be two provisos. First, the facility would not be allowed to hire needed health professionals from the public sector. Secondly, the facility would agree to be conscripted in whole or in part to provide government services when the public system was not keeping up. The price would be the unit cost in the public system.

Yes there are lots of details for the accountants to fight over, but the essence is that there would be a readily available source for government to ramp up capacity.

There are already facilities that operate this way. The Shouldice Hernia Hospital in Ontario has operated for 75 years treating people from every province and many other countries. Likewise for the Cambie Medical Clinic in British Columbia, which specializes in joint surgery.

Healthview Medical Imaging, a private resource for diagnostic images, could be conscripted to provide services to the Health Authority at its unit cost.

Something of this nature has already been happening. Private sector pharmacists have become a major resource for vaccinations. More recently, their scope has been increased to include prescribing some medications.

It does no harm to the public system if a patient goes to a private facility in Boston for treatment. Actually, it shortens the waiting time for everyone else. Why should it be a problem if the facility is in Bedford?

This is not two-tier health care. It is not letting people buy their way to the front of the line for publicly funded health care. It is letting them buy outside the system, which shortens the wait for all those inside the system.

Nova Scotia’s list of people waiting for care would be much longer if we did not have Scotia Surgery, Healthview Imaging, Maple’s telehealth service, and pharmacists providing vaccinations and prescriptions. It would be much shorter if there were twice as many of them.

Privately funded health facilities can represent a valuable resource that the public system can recruit when needed, providing much needed scalability.


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