Let’s face it – Canada does not have a universal system.
The defenders of Canada’s health- care system frequently point to the universality of the Canada Health Act. When introduced in 1966, selected healthcare services were intended to be delivered as a one-tiered system.
The world has changed in the past 40 years – yet the proponents who support the act continue to view small businesses as a threat, even while further involvement by small businesses in providing health- care services are provided for under the legislation.
The reality is, Canada does not have the one-tiered, universal healthcare system that our federal and provincial health ministers proclaim. Canada’s system has evolved into a four-tiered system, an evolution often overlooked by those arguing against a greater role for small businesses in the delivery of provincial health- care services.
Unlike other Canadians, federal politicians and a few others have immediate access to private medical services. The British Columbia Workers Compensation Board (WCB) has legislation in place that enables its clients to go to the front of the healthcare line. Canadians who can afford it can travel to the United States or another country to avoid delays in obtaining health care. The rest of us participate in the current rationed program.
Small business in the health- care industry is a fact of life. Every doctor’s office is a small business. Why then shouldn’t other small businesses be permitted an expanded role in the marketplace? Monopolies are not a good thing.
It is estimated that 1.5 million Canadians are employed directly by the healthcare and social service industries. Under the Canada Health Act, Canada spent $44 billion, or 42.4 percent of its total public and private health expenditures in 2001-02, to provide healthcare services.
In 2003, 98 percent of all businesses in B.C. were small businesses, defined as having fewer than 50 employees. Micro-businesses (those with fewer than five employees) comprised slightly less than 84 percent of this province’s small businesses. Approximately 971,900 people, representing 58 percent of all private-sector jobs in the province, were employed by small businesses in B.C. during the same year. A good number of small businesses are in the healthcare industry, but not enough.
Roy Romanow, head of the Commission on the Future of Health Care in Canada, has called for comprehensive, long-term national health and human-resource strategies to tackle the immediate issues of supply and distribution, as well as the larger issues relating to the changing roles and responsibilities of health professionals.
The problem has been identified: How can we address the immediate issues of supply and distribution of health-care services? One such strategy would be to consider a greater role for small businesses in the delivery of healthcare services.
Small businesses can successfully contribute to many service areas of Canadian health care. There is ample evidence of the success of the private sector in a number of countries belonging to the Organization for Economic Co-operation and Development.
Alberta’s Ralph Klein government continues to lead the way in Canada, with a shift in the distribution of work between the private and the public sectors in that province. Under private-public partnerships, routine testing has moved from the hospital setting to the private domain while hospitals continue to perform specialized tests. B.C., Alberta, Ontario and Quebec have a mix of private and public laboratories, while Saskatchewan, Manitoba and the eastern provinces maintain an exclusively public lab system.
Private-sector labs are generally not unionized and therefore have more flexibility in human resource policy, resulting in increased competition between the private and public sectors. Many technologists have moved to the private sector, increasing shortages in the public sector.
Alberta has introduced the new Health Professions Act, which defines the scope of practice for the regulated professions. There is also some talk of establishing private hospitals, which would create a greater need for technologists and technicians. B.C. seems to be slowly moving toward an increasing role for small businesses in the healthcare industry.
Reflecting on the issues of supply and distribution, the changing roles and responsibilities of healthcare workers lie at the core of this challenge. We must be prepared to permit small businesses to occupy an increasing role in the provision of healthcare services.
Government must get out of the way.
If it does not, this safety net that is so much the fabric of our Canadian culture may be lost.
Note: This article was originally published in 2005.
