The growing role of private health care in Canada is a hot topic at the moment. Provincial governments are outsourcing elective surgeries to the private sector and are considering or debating the option.

Many Canadians are in favor because they recognize that the public health care system is failing. Many are against it because they fear it will increase inequalities in access to care for the most vulnerable populations, particularly in the context of workforce shortages.

Either way, the Canadian media and politicians are discussing it daily.

But there is a problem. Everyone talks about private care, but no one defines it properly, which leads to a lot of confusion.

Defining a term or concept properly is critical to allow and facilitate healthy conversations and debates. It is the only way reasonable decisions can be made.

So what is, in essence, private health care?

Let us look at some examples. You will see how confusing the situation really is.

An Italian tourist is visiting her children who live in Montreal and plans to stay for a few months. Unfortunately, she develops acute carpal tunnel syndrome and needs a procedure to preserve the nerves in her hand. She is treated in a public hospital, but as a non-resident, she is not covered by the provincial health plan and has to pay the hospital and doctor out of her own pocket.

Surely, she was treated in a public, government-owned, and managed hospital, but the patient paid the bill in full.

This could hardly be considered public health care, could it?

Let’s take a second example.

A Quebec patient is seen by a plastic surgeon at Sacré Coeur Hospital in Montreal for carpal tunnel syndrome and is scheduled for elective surgery. The patient is a Canadian citizen.

However, because of the long waiting times, the hospital and the government agreed with a private surgical center to allow the patient to have the surgery performed by the public hospital’s surgeon in the private surgical center.

The necessary support staff (administrative, nursing, etc.) is provided and paid for by the surgical center. The patient pays nothing out of pocket.

The expenses of the private surgery center are paid by the government, according to their agreement (plus a moderate negotiated margin), and the surgeon is paid by the provincial health system, just as if the surgery had been performed in the hospital.

Many media would call this private medicine because the care was provided in a facility not owned by the public system, and perhaps a profit margin was paid to the facility. This situation happens daily in Quebec, and Ontario has just begun outsourcing surgeries to private facilities using the same model.

A lot of heated debates are going on for or against this.

Is this private or public health care? And what makes the difference?

Here is a third example.

The previous patient’s brother also has carpal tunnel syndrome. He cannot afford to stop working for a long time, so he decides to go to a private surgeon who has opted out of Medicare to schedule his surgery around his schedule and have a less invasive procedure with less downtime.

The consultation and surgery take place in a private surgical center. The patient pays for the medical services out of pocket and does not receive any reimbursement from the provincial health system. The doctor is not paid at all by the government.

This third example leaves no one confused. This is definitely private health care!

These three examples are usually bundled together as private care and are used to fuel a public debate on the subject.

However, they could not be more different, as the medical services were provided in a public hospital in the first scenario and in privately owned surgery centers in the last two.

In the first and last examples, the patient paid the bill entirely. In the second, however, it was fully paid with taxpayers’ money.

So what defines private health care? Is it where it takes place? It is who receives it? Is it who pays for it?

I think that instead of picking the scenario that best fits the debater’s agenda, it might be useful to look at the funding source.

If it is government or public health care money, then it is public care, regardless of where it takes place.

If it is non-government money, such as when the patient, an employer, an insurance company, or another third party pays, then it is actually private health care.

With a simple definition like this, anyone can understand the topic of conversation, and the debates can therefore be healthy and productive.

It would probably not be difficult for policymakers and the media to clarify what they are talking about to the public.

Unless, of course, the state of confusion is deliberately maintained by the debaters for secondary gain? Is that even possible? Maybe.

Jean Paul Brutus is a hand surgeon.