Timely health care—there’s an app for that!

There’s been much discussion recently about the results of a new survey examining the impact of technology on health care. Conducted by Ipsos-Reid, the findings suggest that Canadians—particularly younger Canadians—are eager to adopt new technologies to address their health-care needs and overcome increasingly visible failures in our health-care system.

For example, the survey suggests that seven in 10 Canadians are ready for virtual physician visits. Indeed, 15 per cent of millennials say they have already been diagnosed at least once by a digital doctor. Many Canadians (66 per cent) hope virtual medical consults will give them access to timelier health care—an understandable hope given present difficulties in finding a family doctor and the long wait times to see a physician. A 2016 survey, for instance, revealed that Canadians were least likely (among a group of 11 developed countries) to get a same-day or next-day appointment with a physician, and least likely to receive same-day responses from their regular doctor’s office.

No wonder Canadians are looking forward to virtual medical care.

The emergence of online health care allows Canadians to bypass the conventional single-payer system in Canada, again, with its long wait times. While Canadians could always, in theory, leave the country to access health-care services somewhere else, the cost of doing so, both in time and money, is prohibitive for most.

Now with mobile fitness and diagnostic apps, Canadians can send vital health information to doctors (or, in time, to computers programmed to read electronic images, diagnose from reported symptoms and so forth) located anywhere in the world. In effect, new technology will enable Canadians to buy at least some health-care services from anywhere, and probably at prices affordable for most Canadians.

Bypassing regulated domestic delivery systems to receive cheaper or otherwise preferable services from other global markets has a long history in Canada. For example, bypassing has effectively undermined regulatory restrictions in telecommunications as Internet broadcasting is undoing the elaborate regulatory policies of the Canadian Radio-television and Telecommunications Commission (CRTC) designed to protect Canadian producers and distributors of entertainment. The delivery of health-care services may be the next prominent instance of bypass that prompts changes to existing rules.

Canadians will certainly be willing to buy online medical services from Canadian suppliers, presuming that services are delivered in a timely and personalized manner. However, the Canadian Health Care Act (CHA), as it currently exists, will promote imports of electronic medical services. Why? Because the CHA prohibits extra-billing for medically necessary services under the public insurance scheme. A Canadian willing to pay out-of-pocket for faster medical service can do so legally by an electronic visit to a physician in, say, New Delhi but may have difficulty paying for an electronic visit to a physician with a government billing number in, say, Regina (if deemed to be medically necessary).

In fact, one Canadian app (Maple), though welcomed by patients, is already being criticized by defenders of the status quo because it charges Canadians a $49 fee for video consultations.

Restricting private payment for medically necessary services has traditionally been defended on the grounds that allowing private payment would create a two tier health-care system that might ultimately lead to the contraction, or even collapse, of the publicly-funded system.

Existing research does not support such a claim.

In any case, there’s little that can be done to prevent Canadians from electronically bypassing CHA rules regarding private payment. If regulators try to restrict virtual access to health-care providers outside of Canada, the Google Generation (the term Ipsos-Reid uses for 18-34 year-olds) will use proxy servers to get “on-demand” service—just as they did with Netflix.

In short, the combination of long wait times to receive medical services and technological change will ultimately undermine CHA rules discouraging private payment for, and delivery of, medically necessary services. The Google Generation, and generations following, will be increasingly able to buy those services from private providers online. If governments in Canada fail to address wait-time issues and problems Canadians face in accessing primary care physicians, health-care providers in New Delhi and elsewhere are ready to help Canadians address those concerns—electronically.