Daphne Bramham: Corporate ownership of medical clinics raises concerns, including privacy

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Over the past decade, both large and small corporations have invaded Canada’s public health system by buying and building primary care clinics.

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With much the same discretion, doctors, who have gone on strike in the past to protest government wages, are being brought in as corporate employees.

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It has gone so far that some health policy researchers believe Canada may have passed the tipping point with little governments can now do to regulate them in ways that ensure the interests of the public and patients are protected.

The BC Ministry of Health has incomplete data on walk-in clinics, according to a spokesperson. But of the 516 he has identified, about one in five is owned by a “non-medical corporation.”

The 97 non-medical corporations include Jack Nathan Health, Primacy Management and the multinational Well Health. Of the 97 companies, 27 have applied for government help since it announced a $118 million stabilization fund for primary care clinics.

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The $118 million is earmarked to pay the administrative and general costs of the medical clinics until the new payment system for family doctors comes into effect, according to a ministry spokesperson. Under the new model, total compensation for family physicians is poised to increase by more than 50 percent to an average of $385,000 a year.

For years, the BC government has pursued the Cambie Surgery Center Clinic in court. In December, the Medical Services Commission filed an application for mandate against Telus Health, alleging that it provides preferential access to publicly funded services. This month, it took a similar step against Harrison Healthcare.

But companies like Jack Nathan, Primacy and Well Health have largely gone under the radar.

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That may be changing.

“The ministry is aware of concerns about the growth of large corporate entities in the provision of primary care services and is actively engaging in policy discussions in response,” a spokesperson said in an emailed response to my questions.

In November 2021, Ontario-based Jack Nathan purchased five walk-in clinics in BC, adding to the two he already owned here.

It now employs more than 400 doctors working in six provinces in 80 clinics. All but four are at Walmart Supercenters. It has another 114 clinics in Mexico, all at Walmarts.

The crowning achievement of last year was the opening of a large 4,000 square foot clinic in Victoria.

It seems unlikely that Health Minister Adrian Dix was there for the ribbon cutting.

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According to its unaudited financial statement, revenue is up 77 percent in the first nine months of 2022. But it’s still not turning a profit. So now, he says, he must “focus on reassessing and controlling his operating costs.”

Primacy Management owns more than 150 clinics in Canada, including some in Loblaw stores, including Superstores, and employs 900 physicians. Owned by publicly traded Calian Group Ltd., the Primacy website says it “provides innovative healthcare, communications, learning and cybersecurity solutions.”

As Jack Nathan, the fourth quarter of Primacy results in 2022 marked another record year in revenue growth.

Canada’s largest corporate owner is multinational Well Health Technologies Corp. It owns 20 outpatient clinics in BC, including one at the Richmond community center built for the 2010 Olympics speed skating competition.

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Is website says its more than 2,500 health professionals in Canada and the United States have had more than 4.6 million patient “interactions” and have compiled more than 23 million patient profiles.

The proliferation of these corporate health providers is something Lindsay Hedden, a professor of health sciences at SFU, said governments should have anticipated.

“The horse has now left the stable in corporate influence,” he said. “They should have seen him coming with dentists and vets. But they did not do anything proactive to create policy or legislation to put limits on what companies can do to protect patients and our interests.”

She and others have long raised concerns that this may result in doctors being pressured to see more patients than they otherwise would. There may be incentives to ‘up-sell’ patients on other clinical services and products not covered by Medicare, such as physical therapy, counseling, and nutritional supplements.

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But Hedden said the biggest concern is what happens to personal information.

Without patient consent, commercial data brokers are already collecting and selling anonymous data from these clinics, pharmacies, private drug insurers, and the federal government.

The main buyers are pharmaceutical companies, according to Dr. Sheryl Spithoff and other researchers at the University of Toronto. But governments are also buying it because they themselves do a poor job of collecting and sharing data.

The biggest threat, however, are companies like Primacy, Well Health and Telus, whose data collection is not necessarily covered by privacy legislation.

“Since many Canadian pharmacies and an increasing number of medical clinics and virtual care platforms are owned by large corporations, internal research and development could include very broad uses, such as developing commercial marketing tools,” Spithoff and his collaborators. reported last year in the Canadian Medical Association Journal.

There are one million British Columbians and another five million Canadians without family doctors.

To see a doctor, they often line up hours before the clinics open for the day. They may then spend several more hours browsing Walmart and Superstore until a pager beeps to let them know the doctor can see them.

Do they care what happens to their personal data? Probably.

But what choice do they have? In addition to hospital emergency departments, these clinics are your lifeline.

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