Why private surgeries won’t shorten wait lists

After years of delay, Dr. Brian Day’s case against the B.C. government is now being heard in the B.C. Supreme Court.

Day and his private, for-profit Cambie Surgery Centre are challenging the parts of the B.C. Medicare Protection Act that prevent doctors and private clinics from directly billing patients for medically necessary procedures.

At the heart of the case is the contention by Day that if people were able to spend their money on private surgery or private insurance, those people would receive faster care while wait times in the public system would also shrink.

But if Day wins, those public wait times are actually much more likely to increase. Here’s why: • If more doctors and nurses are recruited into the private forprofit system, fewer of them will be available in the public system. • A private system needs long public wait times to attract patients and make money. Why would anyone pay out of pocket if the same care were freely and readily available in the public system?

Indeed, research evidence contradicts Day’s claim. Australia (one of Day’s favourite examples) had a public system much like Canada’s until it decided to introduce a private, second tier in the 1990s. The result? The private sector reduced the capacity of the public sector to provide for patients, and wait times grew. • When doctors are allowed to practise in both the public and for-profit systems, it creates a harmful incentive for them to prolong their wait lists in the public system in order to encourage their patients to switch over to the private option. • Allowing multiple clinics and doctors to maintain their own competitive wait lists gets in the way of efficient and fair management of surgical wait lists. • But the most important reason that allowing private-pay health care won’t shorten public wait times is this: Those with money will no longer have a stake in demanding improvements to the public system.

To see this dynamic at play, simply look at our education system. There, people are “free” to either stay in the public system or pay out of pocket for private school. Many of those with more money and influence have chosen the latter, and as a result, the public system has also lost their advocacy voices, leading to under-funding, larger classes and eroded supports for children with special needs.

That is not the path we want to follow for health care.

Let’s be clear. The wait times for some surgeries in our public health-care system remain too long. But the cure Day proposes is worse than the disease. There is a better way. A recent Canadian Centre for Policy Alternatives report, Reducing Surgical Wait Times, provides a framework for public innovations that can accomplish this.

But to see these public solutions realized, all of us — rich and poor alike — will have to advocate for them together.