There’s plenty of talk lately about an increased role for personal health-care clinics in Canada, sparked partly by Premier Doug Ford’s plans to significantly increase the variety of Ontario surgeries done in for-profit clinics.
Despite guarantees from Ford and others that it’s going to streamline services and solve the difficulty of long wait times, health-care professionals that CBC News interviewed say there are nuances and that such completely happy outcomes usually are not borne out by the info.
The truth is, data from B.C. and from other countries suggests private, for-profit surgery clinics will likely increase the true cost to taxpayers and will worsen wait times in Ontario hospitals.
What does a ‘private system’ even mean?
To begin, it is vital to grasp that each doctor is a non-public contractor. They bill for his or her services. And that figure — together with nursing staff, overhead and other costs — aspects into the ultimate bill.
“Privatization is such a broad term that it’s mainly useless,” in line with Dr. Melanie Bechard, a pediatrician at CHEO in Ottawa and president of Canadian Doctors for Medicare.
“I truthfully would not know the best way to address questions on privatization without first asking in the event you mean financing or delivery.”
The excellence here is private, for-profit care, which implies clinics which might be often owned by corporations who concentrate on bottom line earnings.
Do private procedures cost less?
For instance, data obtained from the Canadian Institute for Health Information (CIHI) shows that knee substitute surgery in a public hospital, paid by the province, costs about $10,000. The identical surgery in a private clinic can reportedly cost patients as much as $28,000.
When the province pays for the knee substitute surgery in a for-profit clinic, the quantity is kept secret, as a result of confidentiality agreements.
Andrew Longhust, a health policy researcher at Simon Fraser University in B.C., says the dearth of transparency makes it difficult to grasp the true costs.
“Governments are sometimes reluctant or will actively fight the disclosure of that information and so will the clinics themselves,” he said. Clinics, Longhurst added, often provide contracts with unspecific additional costs that usually are not easily visible or broken down, so the profit margin stays a mystery to patients and taxpayers.
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“I feel what’s essential for people to grasp is that the federal government could be very fond of claiming, ‘Well, it’s cheaper in for-profit facilities.’ But plenty of it has not undergone any independent scrutiny.”
That lack of transparency, Longhurst said, has led some health authorities to reverse course when the prices of performing some procedures in private clinics proved to be too high.
In 2011, the Vancouver Island Health Authority dropped plans to outsource MRI scans because they were costlier within the private, for-profit sector. More recently, Fraser Health, one in every of B.C.’s health authorities, purchased two private MRI outpatient clinics, bringing them back into the general public system as a part of the technique to cut health-care wait times.
In 2014, Quebec ended contracts with two private surgical centres for cataract and other surgeries since the costs per case were lower in the general public system.
Does privatization reduce wait times?
Proponents of a for-profit system argue it lowers wait times for procedures. When the Ontario government announced on Feb. 21 that it was moving some surgeries to non-public, for-profit centres, Health Minister Sylvia Jones said she hoped it could help ease high wait times for some procedures. Nevertheless, the most recent data from the CIHI paints a more nuanced picture of those delays.
It showed that Ontario, which desires to follow the lead of other provinces, actually had the shortest waiting times in Canada for hip and knee substitute surgeries in 2021/2022 — 73 per cent of Ontario patients received knee substitute surgery inside six months.
By comparison, patients in provinces outsourcing surgeries to for-profit clinics waited longer. In British Columbia, only 70 per cent of patients received knee replacements inside six months, while in Alberta, it was 53 per cent and in Quebec, 48 per cent.
Only in cataract surgery did Ontario lag behind, with 60 per cent of surgeries being done throughout the 16-week benchmark.
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Do we’d like more clinics?
On Jan. 13, Ontario Premier Doug Ford held up the privately funded Shouldice Clinic for hernia procedures north of Toronto — which performs hundreds of OHIP-funded operations — as a model to emulate and expanded.
“We’d like to have facilities like that to take the burden off the hospitals,” he said.
Nevertheless, sitting recently in a closed operating theatre – the results of budget cuts — Dr. David Urbach, surgical chief at Women’s College Hospital in Toronto, says Ontario doesn’t need more clinics.
“You’ll be able to do operations on this operating room. You need not open those latest facilities.”
Public hospitals, in line with Urbach, are funded to do a particular variety of surgeries per yr, and provincial governments could pay to schedule more surgeries at night or on the weekends. But when there are two parallel and competing systems, an even bigger problem emerges: staffing.
“We’d like people,” said Urbach. “The bottleneck immediately is especially nursing care.”
Each for-profit centres and hospitals recruit from the identical limited pool of health-care professionals, but three years of pandemic fatigue and limited salary increases has led to an exodus from the general public system.
A health care provider or nurse that leaves a hospital to work at a for-profit facility for more cash, can, actually, worsen the broader problems plaguing our health-care system, says Urbach.
Fewer health professionals in public hospitals means longer wait times for surgeries, diagnostics and other procedures.
“We are able to use all of those hospitals if we had the people,” said Urbach.
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Are patient outcomes higher in private clinics?
Ultimately, it’s about best outcomes. And studies of the U.K. and U.S, have shown that for-profit care is linked to barely higher death rates.
In a single study, which tracked seven years of outsourcing between 2013 and 2020 from Britain’s National Health Service (NHS) to the private sector, researchers found that each one per cent increase in private for-profit services corresponded to deaths going up by 0.38 per cent per 100,000 people. Based on that data, the researchers imagine for-profit care might have been accountable for 557 additional deaths from 2014 to 2019.
All of those issues, in line with Bechard, result in a very powerful basic query.
“Once we’re private financing in our system, in multiple examples, it tends to have worse patient outcomes and tends to have more financial inefficiencies. So why would we be seeking to expand that in our existing health-care system?”