Ahead of the federal election, Canadians are worried about access to health care. Some private clinics, which are growing in number, charge thousands a year for primary care and out-of-pocket fees, as many people struggle with a soaring cost of living.
An estimated 6.5 million Canadian adults don’t have a regular health-care provider like a family doctor or nurse practitioner.
Dr. Rita McCracken, a family physician in Vancouver and primary care researcher at the University of British Columbia, said the shift toward private, for-profit clinics continues while principles of the Canada Health Act hang in the balance this federal election. She was recruited by what she calls a boutique clinic, though she never joined.
The Canada Health Act prohibits charging for an essential medical service like primary care that is publicly available, because health care should be based on need, not income. Quebec is an exception due to a Supreme Court ruling.
The private clinic option “takes me out of the public system where anybody has access if they are a patient of mine, and removes me and puts me behind a paywall, essentially,” said McCracken.
McCracken said the for-profit clinic provoked concerns for her, given that an average family doctor in her area looks after about 1,200 patients, while the recruiting corporation said she’d only take on 400 patients.
“What this corporation is trying to do is they are trying to say we’re offering extra services, like for example massage services, but they have medicalized these extras,” McCracken said. “I think they’re walking a very fine line.”
The extras also include publicly “uninsured services” like executive physicals and medically unnecessary cardiac tests, McCracken said.
In Barrie, Ont., Anisa Carrascal had a “terrific” family doctor in Toronto for 10 years, until the physician moved to a new, private clinic. Carrascal received an email from that clinic, notifying her that to continue with the physician, she’d have to pay $4,245 a year.
“That was a bit of a sticker shock,” Carrascal said.
The fee was based on a sliding scale according to factors such as patient age, she said.
Carrascal, who is also a nurse, called health care “an issue you cannot escape.”
The 45-year-old’s message to Canadians this federal election? “Think about 20 years in the future and vote accordingly.”
Hundreds wait in the snow to get a family doctor in rural Ontario
At moments, like when Carrascal’s seven-year-old daughter was sick with a respiratory infection, the mother said she returned to the email. She considered paying up, though never did.
In Quebec, one in four people, about 2.1 million individuals, didn’t have a family doctor in 2022-23.
Quebec physicians can choose to move between the public system and private system. That’s not the case in most other provinces.
Dr. Martin Potter left the province’s public health system after 20 years of practising as a family physician to start up Clinique Santé Plus in 2022.
“It’s been more and more difficult in the last few years in Quebec to access your own family doctor, even if you have one,” Potter said. “Sometimes instead of waiting for days or weeks or waiting for like 10 hours at the ER, they come and see me.”
For urgent care, the clinic in Vaudreuil, Que., about 45 kilometres west of Montreal, charges $150 for a 15-minute appointment. Potter also sees family practice patients, who pay $300 for a regular physical exam.
For Potter, the advantage, he said, is patients don’t need to jump through hoops to see him and vice-versa.
Under the Canada Health Act, Canadians shouldn’t be paying for medically necessary services out of pocket.
In March, the federal government reported that in 2022-23, Canadians forked over more than $62 million out of pocket for medically necessary services they should have received at no cost through their taxes.
Last year, Quebecers paid the most, followed by those living in British Columbia.
Although health care is provincially delivered, each province and territory receives substantial amounts from the federal government through the Canada Health Transfer, the largest of its kind.
Ontario for-profit clinic paid more than hospital for same surgeries
There is a mechanism for the federal government to claw back some of the money from jurisdictions if patients have been charged for medically necessary services. To date, the enforcement has been for privately provided diagnostic imaging like MRIs, cataract surgeries or abortion services.
In 2023, the former health minister pledged to cut down on out-of-pocket expenses Canadians paid for medically necessary services, such as virtual visits with a family physician.
In January, the federal government announced changes that, if implemented, would expand provincial and territorial health coverage to include medically necessary services provided by nurse practitioners, pharmacists and midwives.
From B.C., McCracken said a series of solutions to the lack of primary care providers in the province haven’t been bad for doctors, but haven’t made a big difference for communities and for patients.
McCracken suggested more could be clawed back for boutique primary care.
“I think what we should be expecting our federal politicians to do is to be holding up a standard of what is the minimum healthcare that a Canadian can expect in each province,” McCracken said.
