Critics say privatization of health care in Canada could cause a polarization of services, dividing medical care between premium 'wealth care' service for those able to pay and below standard care for those who cannot.
Tom Koch, 57, is a Vancouver-based ethicist and the author of a score of books about medical and journalistic issues of a moral nature. He describes himself as a democratic socialist. And when it comes to B.C.’s health-care system, he says, “It remains my belief that nobody should receive what everybody can’t.”This placed him in an exquisite dilemma when the private Copeman Health care Centre – Canada’s first private, primary health-care centre – opened in downtown Vancouver last November. His GP of several years, Peter House, announced he was leaving the Seymour Medical Centre to become medical director at this new, private clinic. Koch, who has arthritis, has been very vocal in his opposition to the privatization of health care. But, he admits, “That opposition paled before the need to have a physician who I knew thought like I did about things like pain control. The relationship I had with my personal physician whom I respect outweighed my concerns about private health care.” Koch felt House was much more proactive than his previous doctor. He was informative, a good diagnostician and sympathetic. It took Koch nine months to decide what to do, but in the end he paid his $3,500 and joined the clinic. “I’m not happy about it, quite frankly,” he concedes. Koch’s doctor didn’t have the same qualms when he was asked to join the business as medical director. “I was given the opportunity to work in a low-volume, high-quality primary care model,” House says. “I could never find a business model that would allow that to happen. I wanted to provide more quality in care. I didn’t want to rush everybody all the time, which I’d done most of my career.”In the eyes of some, the Copeman Healthcare Centre is a long-awaited chance for doctors and patients alike to get off the public health-care treadmill and focus on the individual needs of the consumer (i.e., patient), particularly in the areas of disease prevention and promotion of healthier lifestyles. In the eyes of others, it’s a disaster – a free-enterprise money-grab that threatens the foundation of Canada’s health system, dividing medical care into two separate, unequal entities: premium care for those who can pay, and standard or below-standard care for those who cannot. But with an eye to the business opportunity, some research estimates the yearly market in Canada for private medical clinics like Copeman’s could reach $11.5 billion. So what’s really going on here? A May visit to the clinic, on the fourth floor of an office building on Hornby Street, is revealing, not to mention pleasant. Stepping out of the elevator, one enters a large room that looks like the lobby of a fine hotel, with original oil paintings on the walls, a vase filled with stargazer lilies on a sideboard and another with lilacs on a glass coffee table. Neatly arranged along a shelf below the coffee table, the magazines – including a recent issue of Wallpaper – are all current and only lightly thumbed-through. In the spa-like washroom, there’s a shower and complimentary terry cloth robes – no backless paper gowns here. Lavender and bergamot-scented soaps sit beside the wash basin. The Copeman Healthcare Centre is staffed by family doctors as well as other health professionals such as nurses, physiologists and dieticians. All clients pay the same fees, whether they use the clinic a lot or a little. It costs $3,500 in the first year and $2,300 every year after that. No one who can afford to pay is turned away, even those with serious,pre-existing medical conditions. Designed to accommodate 4,000 clients, the clinic is not yet full. When it is, nine GPs will be available, keeping the ratio of patients to doctors about 440 to one, much lower than in most B.C. family practices where a GP typically has between 1,800 and 2,000 patients on file.Don Copeman, 48, is a tall and friendly fast-talker. “I don’t like to call this a waiting room,” he tells me, gesturing around the airy, elegant space with its suede-covered lounge chairs, “because our patients don’t wait. I like to call it areception area.”Copeman, the centre’s sole owner, expects to meet his target of 4,000 signed-up clients bynext spring. How close is he now? He won’t say. “When we open another centre,” heexplains smiling, “you’ll know that we’ve reached capacity.” MSP: PROGNOSIS NEGATIVE Don Copeman wanted to be a doctor. He was in the pre-med program at McGill and Queen’s universities. When he graduated from the latter with a science degree in 1978, he was broke, so he took a job selling medical supplies and instruments. He intended to go back to university, but never did. Instead, Copeman quickly developed a successful business career. “It was very rewarding intellectually, financially and otherwise. I came from a relatively poor family,” he says. “There wasn’t enough to attract me back to medical school, particularly because I was in the medical industry and feeling good about what I was doing. ”In 1997, Copeman became a partner in Vancouver’s False Creek Surgical Centre. He was the CEO for several years, managing the business side of the centre. (This summer, he divested himself completely of his holdings in that clinic in order to devote himself to his own.) Copeman says his years with the False Creek Surgical Centre opened his eyes to our “deteriorating medical system.” But it was his own family’s health problems that galvanized him into action. Copeman has a six-year-old boy, Max, who is autistic. When, as a toddler, the boy stopped speaking, Copeman had to wait several months before he could see a pediatrician. Even worse, the physician did not recognize the symptoms of autism. Max was put on a waiting list for further assessment. Two years later, Copeman received a call telling him that the boy could come in. By then, Max was already receiving private care in the form of behavioural and cognitive therapy known to help with autism. Copeman believes that if he had waited two years to seek treatment, Max “would have lost any chance of recovery. He would be extremely developmentally impaired.” Copeman’s concerns about the health-care system were exacerbated when his brother almost died from a post-operative infection Copeman says was not properly dealt with. And he lost his father, who was in his late 70s, to a rare form of cancer. Copeman maintains there were issues about waiting for an MRI, though he doesn’t say that a faster diagnosis would have changed the outcome.