Ontario is going to lean on private health facilities. Here’s what that could mean for our system
Hire more health-care workers. Free up hospital beds. Ease pressures on emergency departments.
These are some of the key points released Thursday in the provincial government's plan to shore up Ontario's beleaguered health-care system faltering under years of pandemic strain.
But the parts of the plan that swiftly garnered the most attention were those that crack open the door to Ontario funnelling more patients to private health-care facilities, a move the government says will help stabilize the system and clear the massive backlog of scheduled surgeries.
The plan states the province will invest more to increase surgeries in existing private clinics covered by OHIP" and that it will also consider options" to increase the number of OHIP-covered surgical procedures performed at independent health facilities."
Those brief lines that signal an expansion of private health care have critics and some policy experts worried about what it means for patients, employees and the public at large.
Here's how experts the Star spoke to see the promise and perils of what we know of the province's plan.
What are these private' facilities?
Private clinics, also known as independent health facilities, can be operated either on a not-for-profit or for-profit basis, and can provide both diagnostic services, such as blood and urine tests, and surgical procedures, such as high-volume cataract surgeries.
There are currently 906 independent health facility licences in Ontario, according to the Ministry of Health. The sites are licensed under the Independent Health Facilities Act to receive funding from the province to support overhead costs associated with the delivery of OHIP-insured services.
The government's plan suggests more such OHIP-covered procedures would be provided in these private facilities.
Independent health facilities delivered over 19,000 surgical procedures in the 2021-22 fiscal year, which is why we are utilizing their capacity to help reduce backlogs," said Ministry of Health spokesperson Bill Campbell, pointing to ophthalmologic and gynecological surgeries as examples.
How it could work
Kevin Smith, president and CEO of University Health Network, said he envisions partnerships between independent health facilities and public hospitals to increase capacity for high-volume, low-acuity surgeries.
Many of us have been of that opinion for a long time. I don't for a second believe this is about privatization. It's all the same docs, all the same nurses, all the same people," Smith told the Star. So, at most, we'd be paying for the use of somebody else's operating rooms if we needed them. That's my interpretation."
Already, many routine procedures throughout Canada are performed at independent locations, noted Sara Allin, an associate professor at the Institute of Health Policy, Management and Evaluation at the University of Toronto.
They are basically taking care that is lower complexity out of hospitals," she said.
Allin noted that there are a fixed number of providers, which include doctors, nurses and other health-care workers, to work at independent clinics.
We're one province, one system. We need to act like it's a system," she said. There needs to be oversight to make sure the care is high-quality, we're reporting on the wait-times and outcomes as we would in any part of the system, and that there is seamless integration ... and actually providing equitable and high-quality care."
What role will for-profits' play?
Raisa Deber, professor at the University of Toronto's Institute of Health Policy, Management and Evaluation, said a key question she has for the government is whether those brought into the system will be not-for-profit facilities or for-profit corporations.
She noted that while procedures offered in the purely public sphere will be covered by OHIP at both for-profit and not-for-profit independent health facilities, for-profit companies are able to charge patients for other portions of their care.
They can't charge for the doctor services, but they can charge you for your meals, for your overnight stays," Deber said. It can add up."
The big question is: How much do you want to have for-profits in the model?"
Corporations that make a profit from health-care services may be less likely to turn patients away should they not require immediate, specific care, she noted.
An ethical provider will say: No, you don't need this.' But if (a provider) is going to make bucks off that, they may not say it."
A drag on human resources?
Another consideration, and a well-founded one, says Dr. Danyaal Raza, assistant professor at the University of Toronto's department of family and community medicine, is the potential for doctors, nurses and their support staff to jump from the public system to a private system due to better pay and better hours.
He noted, however, that it's not just about degree of pay, but complexity of care.
If you're a capitalist looking to make money, you want to treat patients that are the lowest cost to treat. So those patients tend to be healthier patients. They're cheaper to treat, they have fewer complications, they're more likely to speak English, they're more likely to be wealthy, and more likely that you can put them through the widget factory way faster," said Raza, who is also a past board chair of Canadian Doctors for Medicare.
Smith says this is not what he believes the province has in mind. Instead, he said, publicly employed health-care workers could be given the opportunity to work in some independent health facilities temporarily in a shared working relationship.
Maybe this is an opportunity for our most-stressed nurses from places like ICUs and ERs just for a period of time not to be in the pressure-cooker environment, but to rotate into regularly scheduled kind of nine-to-five services," he said.
If you actually tie this relationship of new access to independent facilities to having to have an active staff appointment at a public hospital and participate in the on-call roster, you immediately level that playing field. They're getting the benefit of more capacity, patients are getting quicker care and we're protecting the hospital."
Dr. Dick Zoutman, professor in the School of Medicine at Queen's University and infectious diseases specialist, meanwhile, said he worries about stripping resources out of the public system.
The province's plan could create competition for skilled professionals amid a worldwide shortage of health-care workers, he said.
The public system needs to have more human resources and all of our available human resources put there with little exception," said Zoutman, who previously was chief of staff at two of Ontario's largest hospital systems.
Along with physicians and nurses being pulled into the private system due to higher wages and more flexible schedules, Zoutman said other health-care professionals, such as medical lab technologists, would also be at risk of being lost from the public system.
We will be siphoning off critical resources that we just don't have."
Concerns about cost-cutting measures
Dr. Shoo Lee, a professor emeritus at University of Toronto and former Paediatrician-in-Chief at Mount Sinai Hospital, said that introducing any private health care means a profit incentive will materialize. That means the system can't simply function; it also needs to make money. And that ends up being done through cost-cutting measures, he said, often done by reducing wages.
What happens when you inject private money into the health-care system, there is a short term boost in capital ... but that doesn't last very long, and the costs will go up," said Lee, 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 for issues in the system.
The article looked at other countries and found further evidence that systems with higher rates of private financing are negatively associated with universality, equity, accessibility and quality of care, as has previously been found in international literature reviews," Lee and his co-authors wrote.
If more enhanced services are offered to those who are willing to pay, this 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 precedents to provide evidence for this," the researchers stated.
Megan Ogilvie is a Toronto-based health reporter for the Star. Follow her on Twitter: @megan_ogilvie
Kenyon Wallace is a Toronto-based investigative reporter for the Star. Follow him on Twitter: @KenyonWallace or reach him via email: kwallace@thestar.ca
Olivia Bowden is a Toronto-based staff reporter for the Star. Reach her via email: obowden@thestar.ca