Health care systems worldwide are grappling with access, efficiency, and sustainability challenges. In Canada, the debate over public versus private care is especially charged, and nowhere is this more evident than in Quebec. The province has the highest number of physicians practicing outside the public system in the country—yet they still account for only 2 percent of all doctors. Instead of vilifying these professionals, policymakers should be asking: What lessons can we learn from this model to improve health care access for all?
The patient experience is more than just wait times.
Discussions around health care reform often focus on costs and availability of services, but one fundamental aspect is routinely ignored: Patient experience. In the public system, patient satisfaction is rarely measured and even more rarely prioritized. Wait times are only part of the issue—patients also struggle with a lack of choice, limited control over their care, and an overall feeling of being lost in an impersonal, bureaucratic system.
Those who opt for private health care in Quebec do not do so merely to jump the queue; they do so to be seen, heard, and treated with dignity. They want control over their health decisions. They are not rejecting universal health care—they are reacting to a system that has failed to deliver timely, patient-centered care.
Workforce exodus: a warning sign, not a policy failure
Critics claim that private health care weakens the public system by siphoning off resources and staff. But this argument ignores reality: Health care professionals are not leaving public hospitals because they are being lured away. They are leaving because they feel undervalued, burned out, and unable to provide the quality of care they were trained to deliver.
Restricting private care will not force these professionals back into a broken system—it will only limit patient choices and further deteriorate the quality of care for everyone. Instead of treating private health care as a threat, policymakers should address the root causes of why professionals are leaving in the first place: Inadequate working conditions, excessive administrative burdens, and a lack of resources.
Public and private can work together—if we let them.
Many high-performing health care systems around the world—including those in Europe—successfully integrate public and private options. These systems ensure timely access while maintaining core principles of equity and affordability. Instead of doubling down on a failing monopolistic model, Quebec and Canada as a whole should consider reforms that encourage collaboration between sectors.
For example:
- Tax incentives for private health care expenses could help relieve financial burdens on patients while reducing strain on the public system.
- Hybrid practice models that allow physicians to work in both sectors could prevent workforce flight while increasing patient access.
- Private insurance for select services, as already allowed for dental care, physiotherapy, and mental health, could be expanded to other areas of care.
Reframing the debate: a call for pragmatism
The conversation around private health care in Canada is often framed as a battle between “profit-driven medicine” and “public good.” This false dichotomy ignores the real issue: Ensuring timely, high-quality care for all patients.
The question is not whether private health care should exist—it already does. The question is how we can integrate it more effectively to strengthen our entire system.
Quebec has an opportunity to lead the way in reimagining a health care system that respects patient choice while maintaining accessibility and equity. Instead of clinging to ideological battles, it is time for pragmatic, patient-centered solutions that work for everyone.
Jean Paul Brutus is a hand surgeon.
