The Quebec government has paid significantly more for certain procedures completed in private clinics compared to those done through the public system, data released this week suggests.
The figures, made public through an Access to Information request by the independent Institut de recherche et d’informations socioéconomiques (IRIS), looked at the cost differences for five procedures in public and private settings as part of a provincial pilot project.
The data “couldn’t be clearer,” according to IRIS researcher Guillaume Hébert.
It shows, for example, that the average cost of a short colonoscopy was 2.5 times more expensive in private settings in 2019-2020, costing an average of $739 compared to $290 in the public sector.
In the same period, carpal tunnel surgery in a private clinic was $908, 84 per cent higher than the $495 price tag in the public system.
The numbers are raising concerns about the push for more private health-care options from some politicians, and questions about why the province didn’t release the data to the public.
“For 25 to 30 years right now, we’ve been trying all sorts of private providers, private facilities, even private insurance. In all these cases we observe that the cost gets higher with private health,” Hébert said.
“We should really consider this data before going any further into the use of private facilities right now.”
The pilot project was launched in 2016 by then-health minister Gaétan Barrette, and allowed patients on the public waiting list for five procedures to receive treatment in three private clinics. The goal was to compare the costs across the different models of care.
A spokesperson for current Quebec Health Minister Christian Dubé urged caution about making direct comparisons, saying there are indirect costs that may not have been considered.
That view is shared by Dr. Hugo Viens, medical director for Clearpoint Health Network, which operates two of the private clinics included in the pilot.
“We are surprised that the IRIS publication fails to mention that the indirect costs of public institutions do not include building renovation and equipment depreciation costs, whereas they are included for private clinics. These are significant costs,” Viens said in a written statement.
But Hébert dismissed those concerns, maintaining that both indirect and direct costs were taken into account for both the private and public numbers.
The health ministry also said the situation has changed as the province learns more about how to compare costs between the two systems, and argued that the private sector helps improve access to care for patients.
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Concerns about lack of transparency on numbers
The fact that it took an Access to Information request for the comparisons to become public is troubling for some critics.
“It is quite interesting but also a big concern that this data was not made public — it was not used to inform public debate on these issues or public decision-making,” said Andrew Longhurst, a health policy researcher at Simon Fraser University in B.C.
“We have governments moving toward increasing greater for-profit involvement in surgical delivery at a time when we see this evidence that shows clearly that it is more expensive than public delivery.”
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Damien Contandriopoulos, a nursing professor at the University of Victoria, said the data isn’t surprising.
“The evidence — you can look around the globe — can show that private delivery works to some extent, but it’s not cheaper and it’s not faster,” he said.
Still, Contandriopoulos doesn’t expect the push for more private health care to die any time soon.
“It’s a zombie idea — zombie in the sense that ideologically, there are a bunch of people that are going to try to get it out of its tomb … forever, even though from an accounting point of view those ideas are dead,” he said.