Under the Radar: Stealth Development of Two-Tier Healthcare in Canada

Davidson, Alan

doi:10.12927/hcpol.2006.18334

Cited by 3 publications

(1 citation statement)

References 112 publications

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“…As mentioned above, many enterprise platforms do not offer in person assessments meaning that physicians working for these platforms can only treat simple medical problems. Patients who have complicated health issues are shunted to the emergency department or back to their regular primary care provider (28,32,33). This may increase the burden on the public health system (30,31).…”

Section: Discussionmentioning

confidence: 99%

Enterprise healthcare physician services in Canada: an environmental scan

Spithoff

Mogic

2022

Preprint

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BackgroundEmployers in Canada are increasingly offering physician services to their employees, often through enterprise virtual care platforms. To date however, little work has been done to understand this method of organizing and delivering care.ObjectiveTo understand the nature, extent and implications of enterprise virtual care in Canada.MethodsWe conducted structured internet and database searches to identify enterprise virtual care platforms and their public websites. To answer our research question, we extracted data from their websites, and linked company documents, including investor reports, and information from Mergent Intellect, a web-based application with business data on Canadian companies.FindingsWe identified nine companies offering enterprise virtual care physician services to employees in Canada on behalf of their employers. According to enterprise virtual care company claims, over four million Canadian employees and their family members have access to enterprise virtual care services. All platforms offer virtual physician services to employees and four also offer in person visits arranged through their platforms. Eight of the platforms provide primary care services and one offers only addiction medicine services. Four of the platforms offer to communicate and share information with an employee’s regular primary care provider. Four state they share aggregate or de-identified health data with employers.ImplicationsEnterprise virtual care companies provide millions of Canadian employees and their families with access to physician services. These services appear to disrupt continuity of care (care by the same provider over time) and pose risks to privacy. As other Canadians do not have access to these services, enterprise virtual care is also introducing two-tiered health care broadly across Canada.

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Section: Discussionmentioning

confidence: 99%

Enterprise healthcare physician services in Canada: an environmental scan

Spithoff

Mogic

2022

Preprint

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Concierge, Wellness, and Block Fee Models of Primary Care: Ethical and Regulatory Concerns at the Public–Private Boundary

Reid

2016

Health Care Anal

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In bioethics and health policy, we often discuss the appropriate boundaries of public funding; how the interface of public and private purchasers and providers should be organized and regulated receives less attention. In this paper, I discuss ethical and regulatory issues raised at this interface by three medical practice models (concierge care, executive wellness clinics, and block fee charges) in which physicians provide insured services (whether publicly insured, privately insured, or privately insured by public mandate) while requiring or requesting that patients pay for services or for the non-insured services of the physicians themselves or their associates. This choice for such practice models is different from the decision to design an insurance plan to include or exclude user fees, co-payments and deductibles. I analyze the issues raised with regards to familiar health care values of equity and efficiency, while highlighting additional concerns about fair terms of access, provider integrity, and fair competition. I then analyze the common Canadian regulatory response to block fee models, considering their extension to wellness clinics, with regards to fiduciary standards governing the physician-patient relationship and the role of informed consent. I close by highlighting briefly issues that are of common concern across different fundamental normative frameworks for health policy.

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A Case Study and State of Science Review: Private versus Public Healthcare Financing

Sampath¹,

Wilson²

2011

GJHS

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Medicare is a popular program in Canada that offers universal access to medically-necessary healthcare services for all Canadians through a public insurance plan in each province. In spite of its popularity, healthcare privatization has been debated, often over concerns about wait times for select healthcare services. A case report focused on the 2005 Supreme Court’s response to the “Chaoulli v. Quebec” challenge of the Quebec law banning the purchase of private health insurance for publicly-insured services is presented, along with findings from a state of science review to determine if there would be any benefit from adopting the United States model of private health insurance. This review reveals private health insurance would have significant negative implications, especially by creating inequity in healthcare access for low-income groups. Further study is needed to determine whether Canada’s publicly-funded healthcare system would benefit in any way from increased private financing.

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Under the Radar: Stealth Development of Two-Tier Healthcare in Canada

Cited by 3 publications

References 112 publications

Enterprise healthcare physician services in Canada: an environmental scan

Enterprise healthcare physician services in Canada: an environmental scan

Concierge, Wellness, and Block Fee Models of Primary Care: Ethical and Regulatory Concerns at the Public–Private Boundary

A Case Study and State of Science Review: Private versus Public Healthcare Financing

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