Ontario will rely on private health facilities. Here’s what it could mean for our system

Hire more healthcare workers. Free up hospital beds. Relieve pressure on emergency services.

These are some of the key points released Thursday in the provincial government’s plan to shore up Ontario’s beleaguered health care system, which is reeling under years of pandemic pressure.

But the parts of the plan that have quickly gained the most attention are those that open the door for Ontario by directing more patients to private health care facilities, a move the government says will help stabilize the system and eliminate the huge backlog of scheduled surgeries.

The plan states that the province will invest more to increase surgeries at “existing OHIP-covered private clinics” and will also “consider options” to increase the number of “OHIP-covered surgeries performed in independent health establishments.

These brief lines signaling an expansion of private health care have critics and some policy experts worried about what this means for patients, employees and the general public.

Here’s how the Star’s pundits spoke to see the promise and the perils of what we know about the province’s plan.

What are these “private” facilities?

Private clinics, also known as independent health facilities, can be operated on a not-for-profit or for-profit basis and can provide both diagnostic services, such as blood tests and urine, and surgical procedures, such as high-volume testing. cataract surgeries.

According to the Ministry of Health, there are currently 906 independent health facility licenses in Ontario. Sites are authorized under the Independent Health Facilities Act to receive provincial funding to cover overhead costs associated with providing OHIP-insured services.

The government’s plan suggests that more procedures covered by OHIP would be provided at these private facilities.

“Independent health facilities performed over 19,000 surgeries in the 2021-22 fiscal year, which is why we are using their capacity to help reduce backlogs,” the Ministry of Health spokesperson said. Health, Bill Campbell, citing eye and gynecological surgeries as examples.

What do you mean could work

Kevin Smith, president and CEO of University Health Network, said he is considering partnerships between independent health facilities and public hospitals to increase capacity for high-volume, low-acuity surgeries.

“A lot of us have been of this view for a long time. I don’t believe for a second that this is about privatization. It’s all the same doctors, all the same nurses, all the same people,” Smith told the Star: “So at most we would pay for the use of someone else’s operating rooms if we needed to. That’s my interpretation.”

Already, many routine procedures across Canada are performed in independent locations, noted Sara Allin, an associate professor at the University of Toronto’s Institute for Health Policy, Management and Evaluation.

“They basically take care of less complex care outside of hospitals,” she said.

Allin noted that there is a fixed number of providers, which include doctors, nurses and other health care workers, to work in independent clinics.

“We are one province, one system. We have to act like it’s a system,” she said. “There needs to be oversight to make sure the care is of high quality, we report on wait times and outcomes as we would in any part of the system, and that there is a seamless integration…and in fact provide fair and high-quality care.”

What role will for-profits play?

Raisa Deber, a professor at the University of Toronto’s Institute for Health Policy, Management and Evaluation, said a key question she has for government is whether those who will be brought into the system will be non-profit institutions or for-profit corporations.

She noted that while procedures offered in the purely public sphere will be covered by OHIP in independent for-profit and not-for-profit healthcare facilities, for-profit companies may bill patients for other parts of their care.

“They can’t charge for the doctor’s services, but they can charge you for your meals, your overnight stays,” Deber said. “It can add up.”

“The big question is, how much do you want to have for-profit corporations in the model? »

Companies that profit from healthcare services may be less likely to turn away patients if they don’t need immediate and specific care, she noted.

“An ethical supplier will say, ‘No, you don’t need it.’ But if (a supplier) is going to make money from it, he may not say so.

A brake on human resources?

According to Dr. Danyaal Raza, assistant professor in the department of family and community medicine at the University of Toronto, another consideration, and well founded, is the possibility of doctors, nurses and their support staff to move from the public system to a private system. system because of better pay and better hours.

He noted, however, that it’s not just about the degree of compensation, but about the complexity of care.

“If you’re a money-making capitalist, you want to treat the patients who are the least expensive to treat. These patients therefore tend to be healthier patients. They’re cheaper to deal with, they have fewer hassles, they’re more likely to speak English, they’re more likely to be wealthy, and you’re more likely to get them through the widget factory much faster” said Raza, who is also a past chair of the board of Canadian Doctors for Medicare.

Smith says that’s not what he thinks the province has in mind. Instead, he said, publicly-employed health care workers could be given the option to work temporarily at select independent health facilities under a shared employment relationship.

“Maybe this is an opportunity for our most stressed nurses from places like ICU and ER just for a period of time not to be in the pressure cooker environment, but to move on to regular nine-to-five services,” he said.

“If you really tie this relationship of new access to independent facilities to the need to have active appointment of staff in a public hospital and to participate in the call list, you immediately level the playing field. They benefit from greater capacity, patients receive care faster and we protect the hospital.

Dr Dick Zoutman, a professor at Queen’s University School of Medicine and an infectious disease specialist, said he was concerned about taking resources away from the public system.

The province’s plan could create competition for skilled professionals amid a global shortage of healthcare workers, he said.

“The public system needs more human resources and all of our available human resources, bar none,” said Zoutman, who previously served as chief of staff at two of Ontario’s largest hospital systems.

In addition to doctors and nurses lured into the private system due to higher salaries and more flexible hours, Zoutman said other healthcare professionals, such as medical laboratory technologists, would also be at risk of being lost from the public system.

“We’re going to siphon off critical resources that we just don’t have.”

Concerns about cost-cutting measures

Dr Shoo Lee, professor emeritus at the University of Toronto and former chief pediatrician at Mount Sinai Hospital, said the introduction of any private health care system means a profit incentive will materialize. This means that the system cannot just function; you also have to make money. And that ends up being done through cost-cutting measures, he said, often by cutting wages.

“What happens when you put private money into the health care system, there’s a short-term increase in capital…but it doesn’t last very long and the costs will go up,” Lee said. , co-author of research published February 2021 in the journal Healthcare Policy that examined whether increased privatization of health care in Canada would be the right solution to the problems of the system.

The article looked at other countries and found “additional evidence that systems with higher rates of private financing are negatively associated with universality, equity, accessibility and quality of care , as has already been found in international literature reviews”, Lee and his co-authors. wrote.

If more improved services are offered to those who are willing to pay, it will reduce equity, the report notes. Regulations that restrict a parallel, private system could protect the core values ​​of Medicare from being dismantled, but there is “a lack of precedent to provide proof of this,” the researchers said.

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