Why are we letting corporate medicine take hold in Vancouver’s new urgent care centres?

The BC government has rolled out a flurry of impressive measures to strengthen our public health care system over the past two years. Flying below the radar, though, is a new effort by for-profit corporations to push their way into BC’s health care system — and the Vancouver Coastal Health authority seems to be waving them in through the front door.

But let’s start with the good news. The provincial government has made major investments in seniors care, improved access to MRIs, taken evidence-based action to reduce hip and knee surgery wait times in the public system, expanded PharmaCare coverage and built new hospitals as public projects (rather than as wasteful public-private partnerships, which had become common under the previous government).

Another important initiative is the government’s effort to reform BC’s primary care system and move to a team-based model of care. At a time when many in BC are unable to find a family doctor, this means both expanding access to primary care and designing it to include an interdisciplinary team, including doctors, nurse practitioners, social workers and other health care professionals. A large body of evidence shows this approach supports improved health outcomes while increasing the overall efficiency of the health care system, as CCPA research has long noted.

As part of this broader primary care reform effort, health authorities around the province are rapidly rolling out new Urgent Primary Care Centres (UPCCs). These centres are meant to provide an alternative to emergency departments and walk-in clinics for urgent (but non-life-threatening) health care needs.

Swift action on the shift to team-based care is good news, though it’s worth noting that the UPCC model has its limitations. As previous CCPA work has discussed, the backbone of a team-based primary care system should be a major expansion of community health centres (CHCs). CHCs are non-profit, community-governed primary care centres that emphasize long-term, relationship-based care delivered by an interdisciplinary team of practitioners.

In contrast, UPCCs don’t involve an ongoing, long-term relationship between the patient and practitioners. While UPCCs can certainly be part of a well-designed primary care system, the emphasis should be on expanding the network of community health centres in BC. It is also vital that UPCCs be community-governed (as CHCs are) and run on a public or not-for-profit basis.

Unfortunately, there is an alarming development taking place under the watch of Vancouver Coastal Health: the creation of for-profit (investor-owned) UPCCs. A private business called Seymour Health was contracted by the health authority to run the first Vancouver-based UPCC, which opened its doors on Hornby Street in November 2018. While health care services are still free to members of the public who use the facility, the investor-owned model is deeply concerning on a number of levels.

First, there is ample evidence that public and not-for-profit providers deliver better health outcomes than their private counterparts in hospitals and surgical clinics, seniors’ care and primary care. In addition, for-profit health care is more costly and inefficient than public care — due to private providers’ interest in wide profit margins and to administrative costs being duplicated across multiple firms. Indeed, the for-profit sector is the biggest source of waste in Canada’s broader health care system.

Furthermore, if we allow for-profit medicine to push further into BC’s primary care system, it will enable the creation of an even more powerful industry lobby. Entrenched corporate interests have often successfully blocked evidence-based health care reform to protect their profits, sometimes for decades. Canada’s largely private (and highly inefficient) system of pharmaceutical drug coverage is a prime example of this lobbying power in action, as is the privatized and staggeringly inefficient US health care system. In BC, private surgical clinic investors, led by Brian Day, are trying to pry open the floodgates to privatization by challenging foundational laws that underpin our universal public health system.

It is difficult to see why British Columbians should settle for poorer care at a higher cost in the form of for-profit UPCCs. But this arrangement is a great deal for companies like Seymour Health. On top of the operating payments Seymour receives from Vancouver Coastal Health, documents obtained from Freedom of Information requests suggest that they also received nearly $2 million to renovate the UPCC property on Hornby Street. The health authority is leasing the property from a private owner — meaning it appears to have used public dollars to enhance a privately owned real estate asset.¹ This is an unwise use of public capital investment dollars that could instead be invested in publicly owned assets.

Worse still, this corporate-style medicine may soon be expanded by the health authority in the form of another investor-owned UPCC and “Health Care Hub” planned for South Vancouver. Vancouver Coastal Health recently solicited expressions of interest from potential bidders to run a variety of services at a new facility to be built on the Pearson Dogwood lands (near Cambie St. and West 57^th Ave.).

Documents obtained by the CCPA show that Seymour Health, as well as some even larger for-profit health care corporations, made detailed submissions to run the centre. Seymour Health’s submission says it wishes to expand on the model of its other UPCC on Hornby Street by providing both urgent and ongoing primary care services. It also proposes to buy the property and then lease back some of the space to the health authority. As with other wasteful public-private partnership-style infrastructure contracts, this “sale-leaseback” arrangement would help raise capital funds in the short term, but would increase total costs to the government in the long-term (which is precisely the attraction for the corporation).

The Request for Expression of Interest released by Vancouver Coastal Health confirms it is open to selling off the portion of the Pearson lands that it still owns. The health authority sold off most of these lands to the housing developer Onni Group in 2015 for $300 million and they now appear to be worth upwards of $800 million.² This is a staggeringly wasteful sell-off of valuable publicly owned urban land, which government could have developed to create badly needed new affordable housing.

Other notable submissions came from two of Canada’s largest corporations in the health care sector, CBI Health Group and Jack Nathan Health. CBI is a private equity-owned health care business headquartered in Toronto with more than 250 facilities and 12,000 employees, and has a particular focus on rehab and physiotherapy as well as seniors care (its submission can be found here).

Jack Nathan Health describes itself as “one of Canada’s largest privately owned urgent care providers” and “operates in three countries with additional global expansion in the planning phases.” The company highlights its strategic partnership with Walmart — such as a recently opened massive new medical centre inside a Walmart retail store in Vaughan, Ontario and other clinics in Walmarts around the country, including in the Lower Mainland.

Instead of inviting in these for-profit firms, why isn’t Vancouver Coastal Health running the UPCCs and other proposed health care services themselves or by partnering with community non-profits?

This would be in keeping with practices elsewhere in the health care system. UPCCs owned by the public health authority have been established in Surrey and Kamloops and Vancouver Coastal Health already plans to directly operate other community health services at the Pearson site alongside the UPCC and Health Care Hub. In contrast, the decision to solicit bids for the UPCC through a Request for Proposals-style process, which best suits deep-pocketed corporations, seems primed to help corporate medicine make new inroads into our public health care system.

A related concern is the plan to move the existing South Vancouver Community Health Centre (on Knight St. near East 49^th Ave.) to the Pearson Lands, consolidating all of these services at this single location. In 2015, the health authority closed down the physician and team-based primary care services at the South Vancouver CHC, though it maintained many of the public health and prevention services that were so essential to people living in that area. South Vancouver is home to a large proportion of immigrants whose first language is not English and who typically have lower family incomes, lower employment levels and lower education levels than most other areas of the city.

Yet the health authority appears to have done only a cursory consultation of the people who will be served by the new facility about their needs (and even this came only after  Vancouver Coastal Health had solicited submissions from possible corporate bidders).³

In short, soliciting bids from private corporations does not lead to the community-centered services BC needs. Given the evidence that for-profit medicine means lower quality of care and higher costs — not to mention the basic principle of keeping our health care system public — why is Vancouver Coastal Health entertaining the for-profit model at all? The health authority’s moves towards corporate health care delivery take us in the opposite direction of the impressive range of reforms taking place in BC’s public health care system. A swift change of policy is in order here.

Notes

1. The land title is owned by a company called 1290 Hornby Street Ltd., but it’s unclear who owns this company.
2. According to BC Assessment data for the land parcels on the site. Notably, the BC Auditor General recently released a report emphasizing the need for proper cost-benefit analyses to be carried out prior to public land sales.
3. There was also consultation as part of a plan to replace two other existing facilities on the site, Pearson Centre and Dogwood Lodge, which serve seniors and adults with physical disabilities.

Topics: Features, Health care, Privatization, P3s & public services