New privatized virtual health program a step in the wrong direction for Nova Scotia

The Nova Scotia Health Authority’s plan to deliver virtual care to patients without a primary care provider by using a private, for-profit telehealth corporation based in Toronto is concerning and is a potential trojan horse for two-tiered healthcare. While using technology to expand remote access to primary care is a good and necessary development, partnering with for-profit service provider Maple is a mistake.

Virtual and telecare are important parts of the future of public healthcare. They cannot replace in-person visits with a doctor or nurse practitioner, but remote meetings with medical professionals can be a part of a system of primary care which helps patients get the care they need in a way which works best for them. The pandemic has shown that, in many cases, telephone consultations can work and improved video technology and internet infrastructure mean that virtual care is an opportunity to expand the ways that public healthcare is delivered. However, there is no reason for a private vendor whose core business is fee-for-service, for-profit primary care to be used to introduce virtual care to the province.

Since the program will use only physicians already licensed to practice in Nova Scotia it will not increase physician capacity in the province. Instead, it will simply shuffle resources around, removing physicians from in-person care and sliding them into the new Maple-facilitated virtual system. Worrisomely, if this serves as a wedge for Maple to introduce it’s fee-for-service model to the province, meaning that this deal risks becoming a first step towards reducing physician capacity in the public system. Research overwhelmingly shows that introducing private, pay-to-use services actually increases wait times in the public system by siphoning off medical staff. In addition, the money which Maple will pocket as profits is money that is not being spent on frontline services or building public system capacity.

Maple is a privately owned, for-profit company. It was founded in 2015 by Brett Belchetz, a former emergency room doctor and former McKinsey and Company management consultant. In September 2020 Loblaws Corporation, the owners of Atlantic Superstore PC Financial and Shoppers Drugmart, invested $75 million dollars in exchange for minority ownership in the company.

Belchetz, a Senior Fellow with the right-wing, free market think-tank the Fraser Institute, has been a vocal opponent of public, universal healthcare and the Canada Health Act. He has consistently called for the introduction of a two-tier system where those who can pay can access better, quicker care through for-profit providers. In 2015, right before founding Maple, he told Rebel News that the Canadian healthcare system was “fundamentally broken” because “the cost to patients is always zero dollars.”

For Maple, a contract with the Nova Scotia Health Authority is a massive opportunity and a wedge into a public-private partnership to build and own the virtual infrastructure for virtual care that our public system will fund and rely on for decades to come. It will also allow the company to build out the physician and consumer base needed to grow it’s direct to consumer business model. Belchetz has said that the biggest barriers to growing the company prior to COVID-19 were recruiting doctors in every province and finding someone else (usually employers or private insurance companies) to pay for patient visits to create patient interest and build attachment to a fee-based service. This deal will provide his company with both a network of doctors interested in working in virtual care and free introduction to the service for thousands of potential customers who will have downloaded the company’s app to their mobile device.

There is no doubt that improved remote care, including virtual care, is a necessity for the public system. The change should be embraced - though it should be done with careful attention to the needs and wants of patients who in many cases will still require regular in person visits and it must not be seen as a replacement for building a long-term relationship with a primary care provider. We also must be careful that the challenges of adopting new technologies and the unequal access to high speed internet in the province do not exasperate existing social and medical inequalities. There’s no reason for a for-profit company to administer and deliver this new form of care.

Nova Scotia can, and should, build and own the digital infrastructure to deliver care. Such a system would not be unique -  in 1998 the province of Ontario launched the publicly developed and operated Ontario Telehealth Network (OTN), which delivers virtual and phone-based primary care in that province. In 2018-19 OTN provided almost 900,000 patient consultations. 

Investing in building its own secure platform for virtual care, and the administrative expertise needed to oversee it, would ensure the province can skip the middle-man and have doctors directly deliver care to patients. Since the spring of 2020 steps have already been taken to offer telecare to patients who already have family doctors and that system has largely worked well, despite its rushed implementation. Scaling this new telehealth care system up, adding video and other improvements, integrating appointment booking and “walk-in” queues for patients without a primary care provider is not a minor tasks, but it’s one which the province should pursue itself. Importantly, this would allow the province to create a single remote-care system that is the same for both those with family doctors/nurse practitioners and those without. As it stands, we are building a confusing program with two parallel systems - one operated publicly and one contracted out to Maple.

After years of inertia on video and phone care the pandemic has created a rush to build a brand new system from the ground up. It would be a mistake for Nova Scotia to tie this system to a for-profit company whose core-business relies on the cementing of a two-tiered virtual care system where those who can afford it can jump to the front of the line.