Commentary
By Bacchus Barua

This will come as no surprise to most Canadians, but our provincial governments are struggling to deliver timely access to health care. Unfortunately, a recent announcement by Mark Holland, the federal health minister, will likely further restrict the few private alternatives available to patients who are failed by the public system.

First, some quick context. According to a report released last year by the Canadian Institute for Health Information, an estimated 5.4 million Canadians (17 percent of the adult population) do not have a family doctor. Faced with this reality, some provinces expanded the scope of practice for primary care nurse practitioners, allowing them to perform certain services usually performed by family doctors.

While some services offered by nurse practitioners were publicly funded (when delivered in traditional settings), this change also led to notable growth in private clinics where patients could pay to receive care much faster compared to publicly-funded family doctors (which many patients simply do not have).

The primary reason for these charges was simple: unlike family doctors, nurse practitioners could not directly charge provincial health-care plans (like in Ontario) when care was delivered in an independent facility.

The benefit of this arrangement was that these independent clinics with nurse practitioners were not beholden to government budgets and restrictions that typically apply to physician payment, so they could dynamically respond to patient demand. Indeed, some private clinics in British Columbia shifted away from physician-delivered care to employ nurse practitioners—precisely to avoid bureaucratic entanglements and provide more timely access for patients.

For Canadians in need, these private nurse practitioner clinics function as a pressure valve, alleviating the burden on the public system and delivering care to patients willing and able to pay.

But all this is set to change according to a new decree by Health Minister Holland who has directed the provinces to cover physician-equivalent care provided by all nurse practitioners—or face the threat of financial penalties from Ottawa for noncompliance. While this may sound like good news for some nurse practitioners, it’s not necessarily good news for patients or taxpayers.

Provincial governments are already unable to fund and deliver enough services to meet the needs of patients, despite spending about 40 percent of their budgets on health care. It’s therefore unlikely they will be able to provide adequate funding to cover the additional services currently provided by nurse practitioners in private clinics.

The likely result of Holland’s decree is that patients will simply lose a valuable private alternative to our crumbling public system, while the total volume of primary care services delivered to Canadians (both public and private) declines.

Clearly, Minister Holland has it backwards. Canadians need a more efficient healthcare system that serves their needs. That begins with the federal government stepping back from healthcare policymaking, freeing the provinces from the failed policy infrastructure imposed by the Canada Health Act (the federal legislation that governs healthcare in Canada). Until that happens, the provinces will remain stuck with an inefficient system that imposes long delays and limited access despite a very high bill for taxpayers.

By forcing provincial governments to cover nurse practitioner services, Minister Holland has imposed additional costs on taxpayers and taken away a valuable healthcare option for Canadians. But if he really wants to improve access to care, he should allow the provinces to explore alternative approaches, so Canadians actually receive world-class access to health care.

Bacchus Barua is a Senior Fellow of the Fraser Institute.