Public Values

Ontario health care delivery changes include assembly-line style private clinics

Under-funded public hospitals to suffer more cuts.

Hurley: There is no doubt doctors stand to benefit from private clinics as they become cash cows.TORONTO, ON, February 13, 2012: Tough talk by Ontario's health minister on salary increases for the province's 25,000 physicians and the creation of new private, assembly-line procedure and surgery clinics should be viewed with a "grain of salt and a lot of questions about the motives behind these clinics, who stands to benefit and the potential risks to the health of Ontarians," says Michael Hurley, the president of the Ontario Council of Hospital Unions (OCHU).

Racing to come out ahead of the February 15 release of a report reviewing public services' cost-cutting, the health minister recently announced health service delivery changes that could include private birthing, knee and hip surgery and medical procedures clinics.

The cost-cutting and massive redesign of health services is coming even though over the last decade, health care spending has shrunk as a percentage of total program spending, down from 46 percent to 42 percent, while Ontario's population increased. In the same period, payments to physicians have increased by 88 percent and drug costs doubled in the last 20 years.

  "What's the impact of moving the routine profitable procedures to clinics and leaving the complex surgeries to under-resourced public hospitals?"

Recently, during an Ottawa Citizen live broadcast session, health minister Deb Matthews was "effusive about the convenience of private dialysis clinics operating in strip malls and assembly-line eye clinic operations," says Hurley. "But we have — as I'm sure many Ontarians have — a lot of questions. Among them are: what's the impact of moving the routine profitable procedures to clinics and leaving the complex surgeries to under-resourced public hospitals?"

In the current system, routine patient surgeries effectively subsidize costlier care for complex patients. Private clinics will skim the least complicated and low-cost patients but likely they will receive the same funding as hospitals that will treat the more complex, high-needs patients. Although clinics will, for now, be prohibited from making profits, they will have ample opportunity to generate large revenues that can be used to "reinvest" as bonuses for doctors or the expansion of more private clinics.

"There is no doubt doctors stand to benefit from private clinics as the clinics become cash cows. Other parts of the health system will however be starved for resources under a new price-based funding model for services. Those most affected will be older Ontarians and children. They are the patients," says Hurley "who the health minister has pegged as the 1 percent consuming 34 percent of the health care budget."

Surgeries and procedures currently provided in Ontario's public hospitals are highly regulated under an intense provincial oversight regime. Private, doctor-run clinics are self-regulating. Patient complaints are made to the independent college that polices doctors.

Minimizing potential risks to patient health under a private clinic model which is essentially self-regulated "is also a concern. We are preparing to fight this step into the past," says Hurley.

Links and sources
  The future of health care in Ontario: assembly-line private clinics

Posted: February 15, 2012

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