Abortion Clinics Must be Fully Funded under the Canada Health Act

Private abortion clinics do NOT violate the Canada Health Act or the principles of universal Medicare.

1. Abortion services have been deemed “medically required” by all provinces. This means that all abortions must be publicly funded, regardless of where they are performed, in hospitals or clinics. Abortion clinics fall under the category of “hospitals” in the Canada Health Act because they deliver a medically required hospital service. That means that any private clinic delivering a medically required service normally provided at hospitals must have that service fully funded by Medicare. The difference between hospital care and private clinic care then becomes moot, since it no longer results in “two-tier” medicine. Private abortion clinics can become fully integrated into our public healthcare system simply by becoming publicly-funded.

2. The politicizing of abortion led to the current situation of one-half of all abortions in Canada being performed at mostly private clinics. Abortion clinics opened in the first place because hospitals were failing to provide adequate services on a fair and equal basis for Canadian women. People like Dr. Henry Morgentaler were forced to open private clinics and work outside the system, just to provide quality accessible services to women. Regardless of why they exist, the clinics are here to stay, and they deserve to operate as part of the publicly-funded system. Further, abortion clinics must remain in private hands as long as abortion is still politicized in Canada, because an anti-abortion provincial government cannot be trusted to operate public abortion clinics.

3. Countless other private “for-profit” businesses are already an integral and major part of our universal Medicare system-private doctors’ practices. Abortion clinics (some of which have non-profit status) can be compared to private doctors’ practices in this context. The main difference is that abortion clinics have higher overheads because they do surgery, including extra costs for nurses, drugs, counseling, and equipment. All these costs should be publicly funded via an operating budget from the Ministry of Health, in the same way that a private radiology lab receives additional funds to cover their operating and equipment costs.

4. Abortion is unique from many other medical treatments in that dedicated clinics are actually better at providing the service than hospitals, generally speaking. In fact, abortion clinics serve as an excellent, proven model showing the effectiveness of publicly funded, privately delivered health care. Abortion clinics are fully accredited and accountable to their provincial College of Physicians and Surgeons, as well as to local health authorities. Abortion clinics usually offer important services not available in hospitals, such as counseling, supportive pro-choice care, 24-hour on-call service, birth control support, reproductive health screening, and more cost-effective aftercare when required. In contrast, hospitals have longer waiting lists, most require a doctor’s referral, many impose some restrictions on abortion services, they can fall victim to anti-abortion politics, and they usually feature a sterile and sometimes judgmental environment, with insufficient privacy and compassion for women. (Public hospitals do play a crucial role in providing two-thirds of all abortions in Canada, and enjoy a few advantages over clinics. )
5. Several private abortion clinics in Canada are still not fully funded (five or six in Quebec, one in New Brunswick) and women must pay out-of-pocket for their abortions. Although this amounts to illegal user fees, this is the provincial governments’ fault. The clinics have been begging for public funding for years. For political reasons, these provinces are violating the Canada Health Act and women’s constitutional rights by refusing to fund clinic abortions, and the federal government has failed to penalize these provinces by withholding transfer payments.
6. Opponents of privately-delivered healthcare often cite higher overall costs to the consumer, but this criticism is based on the assumption that private clinics are profit-driven and charge user fees. This doesn’t apply to publicly-funded abortion clinics. Besides, abortions at clinics are significantly more cost-effective than abortions at hospitals (mostly because hospitals tend to use general anaesthesia rather than local anaesthesia). The average cost for an early surgical abortion at a clinic is about $500, while the cost for the same abortion at a hospital can exceed $1000. Further, in response to opposition to “for-profit” healthcare, we should note that any private clinic, whether publicly funded or not, can choose to operate as a non-profit entity (or could even be required to operate that way by the government).

Footnotes

1. Arthur, Joyce. Spring 2002. Untangling the Canada Health Act. Pro-Choice Press. www.prochoiceactionnetwork-canada.org/02spring.html#untangling
2. Whether a particular service might be sometimes medically required and sometimes not (e.g., MRI’s) is a separate issue with no relevance to abortion. All abortions are medically necessary, since it is impractical and discriminatory to separate out abortions done for “social” reasons from those done for “health” reasons. Besides, childbirth and pre- and post-natal care are fully funded under Medicare, even though “pregnancy is not a disease” and people have children for largely social reasons. All pregnancy outcomes must be fully funded on an equal basis in order to guarantee women’s reproductive rights and equality.
3. Other examples of private entities (often for-profit) that receive public funding for medically required services and facility overheads, include walk-in medical clinics, laboratories, and some hospitals.
4. Arthur, Joyce. Spring 2002. Clinics Are Better Than Hospitals-Really! Pro-Choice Press. www.prochoiceactionnetwork-canada.org/02spring.html#hospitals
5. Hospitals have better security from anti-choice protests and immediate access to emergency care in case of complications. Abortion-providing hospitals are also integral as training centres for new abortion providers. As a proven model for future clinics, we support self-contained clinics inside hospitals where feasible, such as the C.A.R.E. Program at BC Women’s Hospital, and the Women’s Services Clinic at Kelowna General Hospital in BC. These facilities combine the advantages of a standing clinic with a hospital’s protection from political interference and denial of funding.
6. We can’t speak for the cost-effectiveness of other private clinics that provide other types of healthcare. It may well be that private clinics, in general, end up costing the consumer more. If so, abortion clinics would be the exception to the rule.

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