More private health care linked to higher mortality, Quebec study warns

Electrophysiologist Dr. Alexios Hadjis, left, performs a ventricular tachycardia ablation at Sacre-Coeur Hospital, Wednesday, July 26, 2023 in Montreal. The operation is being recorded in 3D and will be used in virtual reality training. (Ryan Remiorz/The Canadian Press)

Experts are concerned about the direction Quebec is taking by increasingly turning to the private sector to provide care to the population (care that is often publicly funded).

A new IRIS study shows that countries with a greater private presence in healthcare have higher mortality rates and lower life expectancy.

The study by the Institute for Research and Socio-Economic Information (IRIS) and the Canadian Centre for Policy Alternatives (CCPA), published on Thursday, analyzed the health-care systems of 25 member countries of the Organization for Economic Co-operation and Development (OECD). The results conclude that countries that allow greater private sector involvement in healthcare achieve poorer results on seven mortality indicators.

The report distinguishes between private funding, i.e. where the money comes from (if it comes from people’s pockets or insurers, it is private; if it comes from the state, it is public), and private provision, i.e. health-care providers such as private hospitals or for-profit institutions.

Canada has a mixed model.

It is in the group of countries with high private funding, but with barely one per cent of its hospitals being private, so it has low private provision.

In fact, Canada leaves a lot of room for private insurance and costs charged directly to patients in certain sectors, such as medication, physiotherapy and mental health, explains Anne Plourde, IRIS researcher and author of the study.

“We have rather mediocre results on most of the indicators we analyzed, five out of seven. Canada performs worse than the average of the countries we selected for the analysis. Even on certain indicators, such as infant mortality and maternal mortality, Canada really stands out with very poor results,” explains Plourde.

“In Quebec in particular, we know that we are engaged in a process of privatizing surgeries in particular. We rely heavily on surgeries, and in home care, we also want to privatize services further, as well as telemedicine. This is one of the areas where the privatization of services is happening a lot, and that is quite worrying.”

Mylaine Breton, Canada Research Chair in Clinical Governance of Primary Care Services and full professor in the Department of Community Health Sciences at the University of Sherbrooke, is particularly concerned about the rise of the private sector in telemedicine.

She notes that there is currently an expansion of virtual consultations, a consequence of the difficulty of accessing health services.

“A recent significant breach is telemedicine, teleconsultations because now, doctors are allowed to work in both the private and public sectors, which is not normally possible,” said Breton. “As a result, patients pay out of pocket for a service that should be covered by the public health-care system. For me, that’s a danger.”

Not just the private sector’s fault

Although privatization undoubtedly has an impact on certain mortality indicators, social determinants such as education and housing are even more important, said Breton.

“One of the determinants of health is the health system, but that only accounts for 20 per cent of mortality. So 80 per cent of mortality is explained by factors outside the health-care system. We may focus on the 20 per cent of the health-care system to explain it, but the major [drivers] are much broader,” she said.

In the same city, for example, Montreal, there are mortality differences between wealthy and disadvantaged neighbourhoods.

Régis Blais, full professor and head of graduate programs in health services administration at the University of Montreal’s School of Public Health (ESPUM), also points out that other variables, such as available resources, including the number of doctors and nurses per 1,000 inhabitants, have not been taken into account.

“The quality of care is not evaluated either. Do two countries with the same level of privatization have comparable quality?” he asks.

Surgeries paid for with the health card

To reduce surgery waiting lists, the Legault government has decided to shift towards the private sector. This situation could cause long-term problems, according to the experts consulted.

Blais acknowledges that surgery waiting lists are long, which is why the government wants to turn to the private sector.

However, he points out that private clinics that perform surgery are starting to resemble private hospitals and private health-care providers.

“This means doctors working in private companies, private surgical clinics where there is equipment to perform hip replacements and many other surgeries that are performed in hospitals,” he said.

The funding is therefore public, but the service is private. The IRIS report shows that when the two are combined, mortality indicators are generally worse.

“We are promised that if we make greater use of the private sector, it will improve access to services. This is the main reason given by governments in various provinces to justify increased privatization of services,” said Plourde.

“Other studies have been published that question the private sector’s claim that it improves access to services even when they are paid for with public funds. But on the other hand, what we see in the study we are publishing today is that even if it did improve access to services, the finding is that there is a link between more room for the private sector in health care and higher mortality. That is very concerning,” argues the IRIS researcher.

Blais says that in the long term, this is not a viable solution.

“In Quebec in particular, [surgeons] say that we don’t have enough operating time, we can’t operate as much as we want in the public system because there is a shortage of support staff, particularly respiratory therapists and nurses,” he said. “This means that these doctors and surgeons, who want to practise their profession, are leaving for the private sector, where they can also recruit staff to assist them in surgery. So, if the private sector is attractive, [...] then these professionals, these doctors and surgeons, are not available in the public sector.”

Breton is also discouraged by the many operating rooms that are underused due to a lack of staff.

She would like the government to “think differently,” not with private firms, but by focusing on better collaboration with university researchers in Quebec.

“I find it hard to imagine how we can’t find models for experimentation with the same funding,” she said.

To stem the exodus of doctors to the private sector, it should be noted that Health Minister Christian Dubé passed Bill 83 last spring, which, among other things, requires all doctors to obtain authorization from Santé Québec if they wish to leave the public system to practise in the private sector.

This report by The Canadian Press was first published in French on Nov. 20, 2025.

The Canadian Press’s health coverage is supported by a partnership with the Canadian Medical Association. The Canadian Press is solely responsible for this journalistic content.