Scotland and Ontario have a lot to teach the rest of Canada about how to improve access to primary care, according to a new report from the Canadian Centre for Policy Alternatives, or CCPA.
Scotland provides a road map for transitioning family doctors from being contractors to being government employees, which reduces their administrative burden. And Ontario provides a good example of how to build team-based health care.
Canada needs to consider these alternative approaches because the current status quo means one in five Canadians — and one in four British Columbians — do not have a family doctor, Andrew Longhurst, report author and senior researcher and political economist for the CCPA, told The Tyee.
This gap is creating an opportunity for privatized health care to creep in, which further undermines public health care, he said.
In 2015 just over 82 per cent of British Columbians were attached to a family doctor. By 2024, that had dropped to 75 per cent, according to the report.
Health equity is also doing poorly.
In 2024, 80 per cent of the lowest-income Canadians were connected to a primary care provider, compared with 86 per cent of the highest-income Canadians, which is a trend that has persisted since 2015, the report said.
In B.C. that gap is wider, with only 74 per cent of people in the lowest income bracket connected with a doctor, compared with 84 per cent of the highest income bracket.
Compounding the problem, poorer people are also more likely to suffer worse health outcomes. In part because they’re less likely to have family doctors, they’re also more likely to rely on hospital care, which is the most expensive form of care, Longhurst said.
“We pay a price when we fail to address those equity concerns,” he added.
Frustrated with administrative workloads
Back when Canada was first setting up its public health system, doctors wanted to maintain their business autonomy and therefore became independent contractors who would bill the public insurance plan, Longhurst said.
But today, many doctors are frustrated by the administrative workload and financial risk that come with running their own clinic. They generally prefer to work in a collaborative clinic setting and have access to pensions, benefits and parental leaves, he said.
B.C. tried to fix the problem in 2023 when it introduced the longitudinal family physician payment model — which let doctors make more money by billing for administrative time and medical complexity of a patient — but that didn’t fundamentally shift how doctors were required to be independent contractors, Longhurst said.
Canada doesn’t expect teachers to build schools, but it expects family doctors to build clinics, he added.
Longhurst said if Canada doesn’t find a way to give doctors what they want, more of them will turn to employment with private, for-profit clinics.
These clinics offer salaries, administrative support and clinic infrastructure and don’t require clinicians to run their own business.
Currently there are 131 non-physician-owned clinics in B.C., making up about eight per cent of the province’s total clinics, according to the CCPA report.
Dr. Danyaal Raza, a family physician and primary care and health policy scholar with St. Michael’s Hospital in Toronto, said there are two main ways corporate-owned, for-profit health care negatively affects patients.
First, private health clinics allow the wealthy to pay to access care, which removes health-care providers from the public sector and makes the overall staffing shortage worse.
The Canada Health Act says patients cannot be charged for medically necessary hospital or physician care, but private clinics are trying to get around this by instead charging thousands of dollars in “annual membership fees,” Raza said.
This still violates the Canada Health Act, he said.
A local example is Telus Health’s LifePlus program, in which patients were required to pay $4,650 in annual membership fees to see a doctor, although Telus claimed the fees were for allied health services, according to CBC .
Selling patient data for profit
The second problem with private health clinics is how they use clinical care to acquire patient data, which can then be sold for profit, Raza said.
Data brokers are buying chains of for-profit primary care clinics so they can mine and sell patient data to researchers, government agencies or — their largest client — the pharmaceutical industry, Raza said.
Pharmaceutical companies use the data to develop “clinical decision support tools” that recommend specific products made by the company.
That’s problematic, because the pharmaceutical industry has a long history of “exercising undue influence on the prescribing habits of doctors in ways that are bad for patients,” Raza said, pointing to Purdue Pharma as an example.
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