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  • Writer's pictureChristina Frangou

Private Health Care Is Here

A growing number of Canadians pay out of pocket for MRIs, hip replacements, even family doctor visits. How a two-tiered system crept into Canada.

MAY 16, 2024

Steven Goluboff has always been an old-school doctor. Over a decades-long career, he’s worked nights and weekends and, on his rare vacations, even taken his computer with him to track patients’ test results. In 2019, at 71 years old, he finally began planning to retire from his Saskatoon family practice. He knew he’d have to find more than one replacement for his patients, however—young doctors want a life outside the office, and they couldn’t be expected to put in the hours he did. So he recruited three replacements and left his practice.

But for Canadians who can afford it, some medical care has become easier than ever to access. A growing number of clinics nationwide are selling MRI scans, prescriptions, pap smears and even surgeries—services once considered primarily the purview of the public health sector—to those who pay out of pocket. Canadians are spending in the ballpark of $100 to speak to a nurse practitioner, who will offer the kinds of care a family doctor typically provides; upward of $600 for an MRI on demand, bypassing lengthy waitlists; and $20,000 or more to travel outside their province to see a surgeon for a hip or knee replacement. There’s never been such a willingness to pay for timely medical care in this country—because sometimes it’s the only way to get it.

Privately paid health care is nothing new in Canada. Mental health, dentistry, prescription drugs, optometry and other needs have always been mostly served by the private sector. People have long had to weigh the costs of buying new glasses, of getting their teeth checked or of seeing a psychologist. In February of 2024, nearly one-quarter of Canadians said they had split pills or skipped doses because of drug costs. I know what this is like. As a freelance journalist, I went years without private insurance and skipped out on filling prescriptions. But I was young and healthy. Many aren’t. One in 10 Canadians with chronic conditions say they’ve ended up in the emergency room because they were unable to afford prescriptions. Many of us live on a teeter-totter, trying to avoid a medical catastrophe without spending anything more than we can afford.

For all that, health care in Canada has traditionally not been big business, especially when it’s urgent and important, such as emergency and life-saving treatments, or access to a family doctor. Working as a journalist covering health care in both Canada and the United States, I’ve always enjoyed the fact that when writing in this country, I’ve rarely had to be a business reporter as well. Covering health in Canada has meant focusing on people, outcomes, systems and laws. It was powerful to write stories, even heartbreaking ones, about Canadian health care, because of the almost mythical ideas of universality, equity and accessibility. There was a feeling of shared investment in protecting the public system. In the U.S., business interests are in play, and financial toxicity—the stress of paying for care—is a major theme when covering it.


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