I have been trying to free myself up a bit to come back to the Unified Health story since the day I wrote the last blog….
Much has happened or exposed itself, quickly in the days after my blog was posted. I heard from many folks, and received further details from members of the health care system in NS. Like many employees, people are shy about exposing their employers’ (NS Liberals) poor choices, but they did let me in on some really good information.
And I heard from one of the members of Unified Health, Rhys Bevan-John. I am not inclined to publish his note to me, because I am not in favour of my blog being used to promote the partial or inaccurate details being shared to convince people that Unified Health is good for us in NS, but I will pull some of his comments to speak further to them.
“First and foremost, just to be perfectly clear, we have not received any money from (I)nnovacorp. Innovacorp is offering us support in the form of access to space so we can host some community events where professionals from all disciplines in healthcare to talk about how we can improve our healthcare system. Bango. That’s it. We’ve had meetings with them and they’ve agreed that they’d like to support us in facilitating conversations around innovation in healthcare.”
Fact, in-kind contributions, like providing meeting space, lab space, venues of any kind, and support are considered a form of funding. According to Innovacorp and Bevan-John, Electric Puppet, a corporation owned by another Unified board member, Ryan Cameron, received “support” (funding) but Bevan-John stated it was not related to Unified Health. However Innovacorp tells a different story on their website, tying the clinic directly to the project they are funding. “The company has a development lab and a content creation studio at the Innovacorp Enterprise Centre, and a VR room that features testing and recording capabilities to the public at the Unified Health Community Triage Centre in Halifax.” So Innovacorp is funding this technology, and promoting the private clinic in their descriptor of the project. Promise of future supports are also on the table… “they’ve agreed that they’d like to support us in facilitating conversations around innovation in healthcare.” Advertising the clinic on the Innovacorp website is also a form of in-kind support.
“The fee we’re charging for nurse practitioner itself does not actually cover the entire cost of the nurse practitioner.” $35/ 15 minutes works out to $140/ hour x 7 hours per day, 5 days per week totals $225,400 if a Nurse Practitioner were to have 6 weeks vacation per year. The average wage for Nurse Practitioners in Nova Scotia, as I stated in my previous blog is $50/hour or $104,000 per year. Even considering benefits and employer’s expenses, that’s a pretty good Gross Profit on her base fees alone.
The premise the clinic has put forth for having a nurse practitioner, is triage service. From there, there are additional services the Nurse practitioner will charge for. Then she will refer the patient to a doctor or specialist or for testing. Or she will assess the options available within the clinic for alternative health care options, massage, acupuncture, etc. So, in theory we could say she is charging a fee to recruit customers for the alternative health care options in the clinic. And we, the taxpayers, pay that again when her fees are deducted, dollar for dollar, from our Health Fund Transfers from the federal government. All $225,000 of it. So the clinic gains off the individuals. And we all lose because of it.
The concept of referrals is an issue as well. While those who have family doctors have to wait weeks in some cases for an appointment, any referrals they need are also delayed by that timeline. But if you have the money to see a Nurse Practitioner, appointments are only days away, and so their referrals jump the line pushing doctors’ patients further down the list. It is not a simple accusation of buttinskis. It is a reality that while we try to be patient in a bad situation, they are going to push our ability to deal with our health issues further off into the future.
Bevan-John went on to explain the business model and purpose of charging a fee, including that it was necessary to further their vision. He and I agree that the NS Government is so poorly funding the healthcare system that private health can easily come in and succeed because people need the medical care, and some can and will pay to see a doctor when there are no other options. But we do not agree that it is appropriate for his clinic to join this shell game. He made the claim that they were trying to open as a non-profit organization. I think he thought that somehow was better than a for profit model, but it is not. Non-profits do not imply bare bones and broke. But he went on to explain that bureaucracy made them do it. I am not sure if he will read this but, if your business model is constructed to be a non-profit, the Registry of Joint Stocks does not make up the rules about how that determination is made. The Societies Act does. Specifically Section 3
3 (1) A society may be incorporated under this Act to promote any benevolent, philanthropic, patriotic, religious, charitable, artistic, literary, educational, social, professional, recreational or sporting or any other useful object, but not for the purpose of carrying on any trade, industry or business.
When you are charging clients for services, you are “carrying on any trade, industry or business“. Even if there was no nurse practitioner, they are charging clients for services.
“Unified Health is staunchly opposed to privatized healthcare, and we hope that the politicians – and people like yourself – can use opening this clinic as a kind of “inoculation” to show them how easy it is for this kind of practice to open (and how receptive much of the public is to it).”
So….. corrupting the Universal Health Care system is teaching the government a lesson….? LOL!!!! That’s hilarious. And either extremely naïve or an outright attempt to bowl me over. Unified Health is not the first private health care service provider to make its way into Nova Scotia. We have private (executive) clinics, MRI clinics, Ultrasound clinics, psychologists, etc. Private ones. And that didn’t teach the government any lessons. And while people need their services, and often pay through the nose for access, they do not understand the impact using them has on the funding for healthcare or the vicious cycle we are in with the reduction of Health Fund transfers due to the desperate decision to access care where it is available. If Mr. Bevan-John does not know this, he has a lot of work to do to build any confidence in the clinic he is part of. The other proof that the NS Liberals are not intimidated by their little clinic impacting Universal Health? They will privatise every element of public service they can before they are gone. This week they announced the $2 Billion investment in private enterprise to replace the main hospital for the region.
I do agree with Mr. Bevan-John on is his observation that the Province is defunding healthcare. He says it is so that big corporate interests (“engulf and devour” – fear mongering?) with profits in mind come to open up shop here. And that may be, but his next assertion is that Unified Health is not a big corporate interest. I would argue that they may be small now, but that is not their long term goal. We were told last month many times in social media posts and news articles, that the CEO was travelling across Canada meeting with others to open up similar clinics, and there are plans to open multiple clinics in NS.
The next issue he brought up compelled me to do a little research. “I was speaking to a NP the other day and she said that physicians being gatekeepers of healthcare and diagnosis is an old boys club. I think it’s systemic patriarchy. Whatever you call it, we are seeking to change it – and we need as many people as we can to join in the fight with us.” This claim made me wonder…. I have always had female doctors, currently, I have a female doctor, my kids specialists have been female doctors…. is it really fair to blame a road block on the good ole boys club in this scenario? According to Physicians Canada, female doctors make up 40% of the total doctors across the province, but female family doctors make up more than half of all family doctors. So, I don’t think it is a completely accurate or fair assessment or an appropriate claim. The Canadian Medical Association pretty much mirrors these percentages as well. There is nothing stopping women from becoming doctors, and the younger generation of doctors are showing increases in females taking up the sword. At the same time, there is nothing stopping men from becoming nurse practitioners.
He closed with a plea for my voice in the fight for healthcare and an invitation to the clinic. He wants my help to keep the big corporations out. And a link to a bizarre video, which in some ways was insulting and other ways was plain weird, and in no way helped his case in convincing me. In fact it made me horribly uncomfortable, but he thought it was “a video attempting to hilariously explain the Nurse Practitioner thing from our point of view.” I would have to say I see nothing hilarious about any of this, and it was not successful in assuring me I had nothing to worry about.
I am not relieved or changed by his informative email. In fact, maybe I am a lot more concerned than I was. Good people, who are equally uncomfortable with the whole situation, sent me comments and notes about how they still aren’t being open about their funding. I would remind everyone that they have been asked multiple times, and there were comments made by staff and board members that conflict with Mr. Bevan-John’s statement that the owners used their own money and the rest of them volunteered their time. If he believes the funding story he wrote me, he should be investigating a lot further into the organization he has joined.
In looking at the Canada Health Fund, Universal Healthcare, and this private healthcare situation, it is not lost on me that Lester B. Pearson, a Liberal, was the Prime Minister credited with introducing Universal Healthcare in Canada. And it was Pierre Trudeau, another Liberal, who enacted the Canada Health Act. My how times have changed.