For-profit healthcare needs to bill private patients AND public medicare

A major limit to the growth of for-profit medical and surgical clinics in Canada has been a prohibition against physicians billing public medicare systems while also charging patients for medically necessary services through a private clinic.

This has led  many doctors to stay in the public system because they can’t get enough work in the private system to fully support themselves, says Cory Verbauwhede, a lawyer for Médecins Québécois pour le Régime Public, a pro-medicare group in Quebec.

 But the Canadian Medical Association Journal reports specialists in Quebec have launched a lawsuit in hopes of striking down the one-or-the-other rule.

 “The law forbidding publicly funded doctors from working in the same setting as a non-participating doctor impedes on the right of people to associate themselves,” says Dr. Gaétan Barette, president of Quebec’s medical specialists’ federation.

The CMAJ reports that Ontario does not regulate such clinics and does not even keep track of how many there are (although it is in the process of 'registering' clinics that provide anesthesia).

It adds that British Columbia lists 66 clinics, many of which do only one type of surgery and about a dozen of which provide a variety of services. Alberta lists 60 in total, including 12 that perform multiple types of surgery. (Neither the BC nor Alberta numbers include private "executive health" or diagnostic imaging clinics.)

The Quebec government does not keep a comprehensive list of private clinics operating in the province but  Dr. Zoltan Nagy, president of the Canadian Independent Medical Clinics Association estimates there are around 300 private clinics there, including several that focus on providing executive health and cosmetic services.

Verbauwhede notes that Quebec clinics are not only expanding in number, but also in size. "They're becoming mini-hospitals," he says, noting that one-day cataract, knee and hip surgeries are increasingly being performed in private clinics

The CMAJ concludes that "the growth in private clinics may soon escalate."


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