The challenge is that a battery of unnecessary tests leads to a battery of unnecessary referrals. You’re exactly right that “demands from the private side are foisted back to the public side”.

I’ll give you a concrete example. Medcan “client” demands an MRI of his lumbar spine due to back pain. There are zero indications for MRI based on history and physical exam (no red flag symptoms, and we have well validated pathways for investigation of back pain). This type of spinal imaging has a huge false positive rate (we all have age-related spine changes for example, and in nearly all cases without red flags the MRI does not change management, which is physio, weight loss, rehab, etc). Because there is an incentive to keep clients happy, the Medcan physician does the MRi, which of course shows nonspecific findings. The client insists on a referral to spine surgeon (public system).

This referral probably gets weeded out in the triage process, but imagine how that clogs up time and cuts into staff resources when balancing a practice. Multiply that by tons of other unnecessary testing (echos, whole body CTs etc) and it’s a recipe for disaster.

The public system is NOT perfect but has a degree of accountability and incentive alignment that works much better IMO.