Using private healthcare: what are the consequences in Manitoba?

But what are manitobans supposed to think of these partnerships?

A public-private partnership (PPP) is an agreement long-term agreement between the government and a private partner, under which the private partner provides and finances public servicesaccording to the Organization for Economic Co-operation and Development (OECD).

These types of partnerships are very common in the healthcare sector, explains University of Sherbrooke associate professor Mylaine Breton.

Mylaine Breton holds the Canada Research Chair in Clinical Governance of Primary Care Services.

Photo: Source: Government of Canada

Most people don’t pay their GP directly when they see them. observes Ms. Breton, who also holds the Canada Research Chair in Clinical Governance in Primary Care.

The doctor’s service is financed by public budget envelopes, but can be provided in a private medical clinic.explains.

A person can then receive health services that are paid for by the government but are provided by private or non-profit organizations.

St. Boniface Hospital in Winnipeg, for example, is a nonprofit organization funded in part by the government, says Manitoba Health Coalition provincial director Thomas Linner.

Maples Surgical Clinic is also an example of a private, for-profit healthcare facility, Linner adds.

The number of partnerships unknown

The province told Radio-Canada it is entering into a partnership with private providers of medical-surgical and diagnostic services for decades.

However, it cannot deliver to complete list of private facilities providing publicly funded care to provincial insureds in Manitoba.

According to the government, the public system currently employs the majority of health workers.

Thomas Linner of the Manitoba Health Coalition laments the difficulty of accessing this information. His organization fights against the privatization of assistance in the province.

I don’t know the share that the private sector accounts for in government investment, he hints. Therefore, he is not even able to know whether investing in the private sector costs more than doing it in the public sector.

More expensive to invest in the private sector?

Former NDP Health Minister Sharon Blady believes the costs are higher below PP extension than to the public.

Someone in this partnership wants to make a profit. The PP extension they are the last step before the system collapses. »

A quote from Sharon Blady, former Minister of Health of Manitoba

His government has already adopted PP extension in the past, but believes that the Progressive Conservatives have a different approach from the New Democratic Party, which he accuses of making several cuts to health care.

portrait of Sharon Blady

Sharon Blady served as Manitoba’s minister of health from 2014 to 2016 under the NDP government of Greg Selinger.

Photo: CBC

It might be worthwhile to privatize on a smaller scale. However, this must be done effectively and only under certain circumstances. You must try to avoid itshe says.

Professor Mylaine Breton also believes it is more expensive for the government to invest in partnerships with the private sector, but believes they are necessary in the current context.

We have a capacity problem and the private sector contributes to the collective effort. We need to develop more partnerships.

However, he believes that these agreements must be made, subject to certain conditions.

PPP and transparency

In 2012, the NDP government approved the Public Private Partnership Transparency and Accountability Act. This law, repealed in 2017 by the Progressive Conservatives, required a detailed analysis of the risks and costs before concluding a PP extensionas well as conducting public consultations.

The province told Radio-Canada that it continues to conduct cost analyses ensure a cost comparable to the care provided by the public sector, based on the needs of patients.

She specifies it such agreements are determined on a case-by-case basis and subject to the protection of the commercial interests of third parties.

Firstly, Mylaine Breton believes that there must be terms and conditions to ensure that working conditions remain favorable in the public system.

It can be much easier to fill positions in the private sector, because the working hours are more favourable. This to the detriment of the same professionals who have to work overtime at very unfavorable times. »

A quote from Mylaine Breton, holder of the Canada Research Chair in Clinical Governance in Primary Care Services

Need [aussi] ensure that the patient does not pay out of pocket. It is the fundamental and most important valueshe says.

The law protects free access to insured care

A private company can provide primary health care services, but the patient doesn’t have to pay for this care, according to the Canadian Health Act.

As long as there are no charges for patients, provinces and territories can provide insured services as they see fitthe federal government told Radio-Canada. This then opens the door to PP extension.

Manitoba Health Coalition provincial director Thomas Linner in an interview at the Manitoba Legislative Building on November 15, 2022.

Provincial director of the Manitoba Health Coalition, Thomas Linner.

Photo: Radio Canada

The Manitoba Health Coalition fears, however, that this free access will be undermined, as the private sector takes up more and more space in the health care system.

There are currently private surgical clinics seeking to be heard by the Supreme Court of Canada for the right to charge their patients additional costs. »

A quote from Thomas Linner, provincial director of the Manitoba Health Coalition

The clinic at the Cambie Surgery Center in Vancouver went to court to be able to bill the services covered by the public plan to patients who wish to go to the private sector. The clinic announced plans to appeal the decision of the British Columbia Court of Appeals that rejected her request.

Mr. Linner also fears that the province will lose control over health care delivery by giving too much control to the private sector.

Manitoba is not a big market for large, privately-owned, for-profit surgical chains. We are a small playerHe believes.

He says his fears stem in particular from Revera’s Parkview personal nursing home, which closed its doors last spring, with the loss of 277 beds.

We have a public system that is better than people think. We invest in this system that has given so much to Manitobans and solve its problems directly from within argues Linner.

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