Can our public health system really afford to go on like this?
Moose Jaw’s South Saskatchewan Heart Clinic opted out of public funding on October 2, 2023. Since then, the clinic has offered private services paid for by their clients and their third-party insurance. Private essential health services are uncommon in Canada since healthcare is usually publicly funded. This is the first private cardiology clinic in Saskatchewan.
This switch from public to private service provides insight into how Canada’s universal healthcare system affects service providers. For example, inadequate funding and non-negotiable fee-for-service rates. Privatizing this essential health service also offers a look into the benefits and detriments of a private healthcare system for the patients.
Dr. Jeffrey Wilkinson’s South Saskatchewan Heart Clinic, established in 2018, specializes in “outpatient evaluation and the management of cardiovascular health,” according to their website. This means their primary demographic is non-hospitalized people concerned about their heart health.
According to the Saskatchewan Health Authority, a cardiologist specializes in the “diagnosis and treatment of diseases or conditions of the heart and blood vessels” and can specialize further in areas such as “interventional cardiology” which is the use of mechanical treatment methods, such as angioplasty, or specific population demographics.
Of the numerous cardiology clinics in Saskatchewan, only Dr. Wilkinson’s clinic is private. According to the Saskatchewan Medical Care Insurance Act, health care providers can opt out of offering insured services as long as notice has been given to the Minister of Health. With that, they can offer uninsured services, privatizing their health care services.
The South Saskatchewan Heart Clinic released a statement on October 13, 2023. In it are the details of why the clinic chose to privatize. “Over the last five years, being a specialist clinic in Moose Jaw has been operationally and financially difficult,” it said.
Among the difficulties was a lack of competitive funding provided by the Ministry of Health. “We had a number of resignations due to the inability to pay competitive salaries and provide benefits,” wrote the clinic. Publicly funded services like the cardiology clinic rely on a “fee-for-service” rate, according to Discover Moose Jaw.
The Ministry of Health determines this rate and pays clinics for every test performed. However, it varies between provinces. As expected, lower rates mean less money to cover clinic expenses.
The statement described these rates, emphasizing the large gap between provinces. “Presently, the rates the Saskatchewan Ministry of Health pays for common cardiac procedures are 20 to 45 per cent lower than either Manitoba or Alberta. […] For example, an electrocardiogram, or ECG, is paid at $34.33 per test in Alberta. In Saskatchewan, ECG is paid at $18.90 per test.”
The clinic chose privatization to continue to provide quality care to its clients and keep itself afloat. However, this was not the first option. As mentioned in the clinic’s written statement, “Our office reached out to both local MLAs – Tim McLeod and Greg Lawrence, […] Dr. Wilkinson also reached out to the Saskatchewan Medical Association and met with the president and CEO in early 2023. Finally, on April 3, 2023, Dr. Wilkinson met directly with Premier Moe and [former Health] Minister Merriman.”
However, despite these meetings, with no foreseeable change to the fee-for-service rates, the South Saskatchewan Heart Clinic decided to go private.
So, although the clinic now offers its services privately, that does not mean all costs must be paid out-of-pocket by the client. Many private service providers, in and outside healthcare, accept personal insurance. The South Saskatchewan Heart Clinic accepts third-party insurance. The limitation of this, however, is the coverage the insurance company provides.
The South Saskatchewan Heart Clinic’s website provides several benefits of private patient services. The website notes that private services offer shorter wait times and faster diagnoses. The clinic also has a cardiologist on-site, so “you don’t need to travel to see a qualified specialist,” and any tests done can be planned so the patient receives their test results immediately.
A downside to this, however, is the costs. The clinic’s website mentions that the consultation, which includes an ECG, is $350 and is only “sometimes […] covered by third party [sic] health insurance. Other cardiac diagnostic testing is charged separately.” So, while insurance may cover some initial costs, it will often not cover further testing.
This already proves to be a significant barrier to healthcare. CBC’s Garth Materie spoke over the phone with Ryan Meili, a family doctor and former NDP leader. In this conversation, Meili described a situation where a former patient had to change clinics because of the cost. She had gone in for an appointment and was “presented with the option of paying $700 to have the exam and the procedures that were needing to be done that day.”
Meili also noted that this patient had not been contacted about this change before the appointment. “She chose to go elsewhere, and now she has to wait.”
From the complicated situation of a cardiology clinic pushed into private services, a need for reformation in public healthcare appears. If a clinic cannot survive on public funding, revisions to the public funding system should be considered. While the current situation provides no solution, perhaps one can be found in a mixture of public and privately funded services.
Perhaps it would be beneficial to implement a system where the government partially subsidizes costs. A system like this could help clinics that cannot survive on public funding alone and clients who cannot afford expensive diagnoses.
The South Saskatchewan Heart Clinic claims to have privatized its services to preserve its standard of care and fulfill its financial needs in a competitive field. Although the switch seems to work for the clinic, the costs of the services have become a significant barrier to timely healthcare for former, current, and potential patients. A better solution, one that does not so clearly distinguish between public and privately funded services, seems to be in order.