opinion | For-profit services are not the answer to Ontario’s health care crisis

Comment

There’s no doubt that Ontario’s public health-care system is strained — to the point of catastrophe.

In November, the average emergency room stay for patients admitted to the province was 22.4 hours. The Ontario government says the waiting list for surgical procedures has topped 200,000. Last fall, patients in one city were left outside in an ambulance bay for hours waiting to be taken to the hospital. Nurses are burned out and abandoned or considered leaving the herd.

These failures are brutal – and can be fatal. But Ontario Premier Doug Ford’s plan to ease the strain by expanding for-profit medical services is the wrong way to fix the problem.

Ford’s plan, unveiled Jan. 16, would move thousands of cataract surgeries, hip and knee replacements, MRIs, CT scans, colonoscopies, and endoscopies out of hospitals and into for-profit and nonprofit community facilities. Many critics see this as a step towards the privatization of public care.

It is not at all. The plan, whose model exists in one form or another in British Columbia, Alberta, Saskatchewan and Quebec, does not require patients to pay out-of-pocket for primary care – medically necessary services will still be publicly funded. – No more allowing wealthy patients to skip the line. David Jacobs, president of the Ontario Association of Radiologists, claims the plan is “consistent with Health Canada” and “is not in any way, shape or form an American-style health care expansion.”

Still, it would potentially allow half a billion dollars annually to flow into private, for-profit facilities. thus, it is a financialization of the medical system, opening it up to become primarily a financial instrument for investors rather than for the public good. Institutional investors entering this sector will aim to maximize their profits. This most likely means either trying to sell more services to patients or running a leaner, no-frills operation. Or both.

The data suggest that for-profit care is costly in more ways than one. A report by the Canadian Center for Policy Alternatives suggests that for-profit changes in British Columbia since 2015 have not solved the province’s health care problems, but have led to illegal overbilling and draining of the public purse. In the United Kingdom, for-profit medical outsourcing has led to an increase in deaths, according to a study published in The Lancet. Ontario has its own homogeneous data on long-term care facilities. For-profit households in the province, which account for about 58 percent of the total, had more COVID-19 deaths per household than non-profit households.

A key concern is that the policy changes will overwhelm the public order by luring doctors, nurses and technicians with the prospect of more money or better hours. Ford has waved about protecting hospitals by requiring community clinics to provide their staffing plans, but there’s no guarantee it will help. Ford also plans to make it easier for out-of-province health care workers to practice in Ontario, but that just compounds the crisis. Meanwhile, bringing in doctors from abroad and training new ones will take time.

There are better ways to deal with this crisis. Moving some procedures out of hospitals is a good idea, says Robert Bell, Ontario’s former deputy health minister, but they should go to non-profit facilities. Danyal Raza, a family physician and assistant professor at the University of Toronto, agrees. Innovation, he says, “will have to take the success from hospital-affiliated community surgical centers and make it the standard.” In Ontario, these surgery clinics are efficient, specialized and private non-profit hospital extensions that perform procedures outside the hospital – outside the pressure of the profit motive. And he has a track record of getting patients to care in the quickest time possible.

The government should also drop its appeal to reinstate Bill 124, which provides for a 1 percent pay hike for public sector workers, including nurses. It was rejected by the courts in November. “Bill 124 has to go,” says clinical nurse specialist Birgit Umaigba, who speaks and writes about nursing from the front lines. The bill, she says, is driving nurses into private facilities — or out of the profession. Umaigba also advocates for speeding up the years-long process to bring internationally educated nurses into the system.

In addition, the province could improve its referral system. Melanie Bechard, a pediatric emergency physician and president of Canadian Doctors for Medicare, says a system of family doctors referring patients to a centralized pool of specialists “has the potential to significantly reduce wait times in Canada and around the world.” proven for. Various specialists – physiotherapists, mental health professionals, dietitians and others – as they process through the system, sometimes even avoiding the need for procedures or surgery altogether, expanding multidisciplinary medical teams Help can be had. None of this requires reinventing the wheel. “We have the right tools for success,” Bechard says. “But we need to expand these models.”

Ontario’s health care system needs reform. It does not require much financing. Instead, the province should reinvest in public and non-profit care while expanding best practices. In that field, unlike doctors and nurses, there is no shortage of ideas that work.

Leave a Comment