Private, for-profit clinics will play a bigger role in Ontario, to help lessen the wait-times for surgeries in the province.
The announcement was made Monday by Premier Doug Ford and Ontario Health Minister Sylvia Jones. The changes are expected to roll out in three phases and are focused on different regions. They are intended to tackle a major backlog for common procedures like cataract operations, MRI and CT imaging, and colonoscopies and endoscopies. By 2024, the government intends to roll out the third phase, which will see hip and knee replacements treated at private, for-profit clinics.
"These procedures will be non-urgent, low-risk and minimally invasive and, in addition to shortening wait times, will allow hospitals to focus their efforts and resources on more complex and high-risk surgeries," the province said in a news release.
Many on social media, including those who work in the healthcare industry, expressed their concerns.
As someone who works in an intentionally underfunded public healthcare system, I am worried sick that Doug Ford is pitching the idea of private surgeries in Ontario. Privatization isn't the solution we need. How is adding a profit component to managing people's health a solution?
— Birgit Uwaila Umaigba (@birgitomo) January 15, 2023
Don’t you love how Ford states that the privatization of healthcare would alleviate the backlog of surgeries and dr’s could perform these surgeries in their spare time. So clinics will compete with hospitals for dr’s nurses and other staff. Look at the shit he has created
— Jeff Larmer (@JeffLarmer) January 13, 2023
Introduce new for-profit surgical centres where patients may be upsold
Operate during the same hours as public hospital ORs
Reimburse them at case rate higher than hospitals
Some patients will be using their CC
Hospitals will lose staff
Unit cost/case for taxpayer will increase
— Michael Warner (@drmwarner) January 15, 2023
If staff are offered better pay and better hours, many will leave. Pension will factor in for some but not late career nurses or young nurses starting out, or for those broken by the horrific working and staffing conditions of the last 3 years
— Kathy (@katie44121) January 15, 2023
Most OR days end at 3:30 pm, @fordnation
No need to pay to build new infrastructure, when your current operating rooms are under-utilized—only used 40 hours a week—help us get staffing to extend the length of the OR day, to eliminate the waitlist https://t.co/MyGdMmWdJY
— Natalie Coburn (@DrNCoburn) January 14, 2023
@fordnation unveils step in his "shock doctrine" Healthcare privatization agenda--more surgeries in private for profit clinics. Fear not. He promises med staff won't leave the hospitals, just as he promised "won't touch greenbelt" & "iron ring around LTC".
— Doug Tripp 🇺🇦 (@doug_tripp) January 14, 2023
You can't create new doctors by changing the legal channels by which they are paid. So is idea of Ford's privatization push that a) existing doctors will work more hours; b) doctors will move from other provinces; or c) the supply problem for surgeries isn't doctors?
— Liam McHugh-Russell @firstname.lastname@example.org (@LMcHugh_Russell) January 16, 2023
Sara Allin is an associate professor at the Institute of Health Policy, Management and Evaluation at the University of Toronto. She says while the details around this announcement are still largely unknown, it appears independent surgical facilities, which are currently playing a marginal role, will see an expansion of capacity. If there is to be an expansion in the long term, it implies that there will be new facilities built. Allin says a big question mark surrounds how we can increase capacity, without increasing our workforce.
“We are facing a workforce shortage and crisis across Canada,” Allin tells Yahoo News Canada. “We don’t have all the workers we need for the current infrastructure, in terms of the current hospital system.”
Will hospital staff abandon ship for private jobs?
Allin says hospitals are well-equipped to do the bulk of complex surgeries that require overnight stays, while stand-alone facilities are well-placed to address more of the lower-complexity interventions that don’t require overnight stays.
She says the main question is how to make sure care is integrated into that system and not increase the fragmentation that the healthcare system already struggles with. The government hasn’t shared a workforce strategy indicating where workers will be needed, and how they will meet those needs.
“That strategy can help with the concerns that have been raised about where workers will come from and not attract people out of hospitals to these independent centres,” she says.
The Ford government has previously announced longterm strategies of increasing the number of seats in existing medical and nursing schools, as well as expediting the licensing of internationally trained workers. However, there hasn’t been anything announced around wage increases, which could help convince people to stay at their jobs or address issues of workers who plan to leave or retire.
What could happen? Lack of data means healthcare impacts unknown
Allin wonders what the roles of hospitals will play in the future – will they partner and take on oversight of these clinics, allowing staff to be transferable? Or will the for-profit clinic work as separate independent centres that are privately owned? In that case, there needs to be efforts made to share data and workforce.
One of the issues in a crisis is being able to move people around, to be able to cooperate and collaborate in order to address surges in demand. We want to make sure we build on this learning on how to maintain a health care system in the face of shock, and not introduce new factors that can undermine the ability to act as a system.Sara Allin, Associate Professor at the Institute of Health Policy, Management and Evaluation, University of Toronto
Allin adds that there isn’t strong data to help evaluate the impacts, if any, this increase in capacity outside of hospitals have on quality and experience of care. While hospitals have well-developed data systems, facilities outside of the primary and community care sector are less developed when it comes to monitoring, measuring and managing performance.
“Are we looking at any adverse events or increase of hospital admissions after surgeries,” she asks. “We need to monitor the quality of care, just as we do in hospitals. This should be a requirement.”
Ontario's healthcare proposal: What will be covered, and what won’t be?
Ford and Jones emphasized that care provided at for-profit clinics will be covered by healthcare, with Ford stressing patients will "never use their credit cards". However, it’s not clear how to regulate a system that has more private, corporate components.
“What might be required to make sure there’s no additional costs placed on patients?” Allin asks. “That we’re actually enforcing the rules around no extra billings and that we’re mitigating any potential harms that might be caused by having more of a profit orientation to these corporations versus those that are more charitable and not-for-profit that are more customarily providing the care in the Canadian system.”
Nathan Stall, a geriatrician at Toronto’s Mount Sinai hospital, says having these facilities help with the backlog of procedures is a positive idea, as long as they are regulated and have good oversight.
Where he’s seeing some opposition stems from is the confusion between what’s publicly financed and publicly delivered healthcare. He says it’s important to get clarity on what’s to come in the province.
“We have to understand that a lot of our healthcare system is already privately delivered, on a not-for-profit basis, and all of it is publicly financed. We have to have that nuanced discussion and understanding so that we are all speaking the same language about what’s being proposed in Ontario or what’s going to be done.Nathan Stall, geriatrician, Toronto’s Mount Sinai hospital