private health care

With proper safeguards, private surgical clinics can play an important role in reducing the stress on Ontario health care, 40 per cent of which is already privatized without issues or public concern.

By Ian Pattison

‘The devil is in the detail’ is an old idiom meaning that hidden somewhere in a proposal there’s a catch. Things that seem simple at first are more complex or require more time and study than expected. It’s a lesson that Premier Doug Ford and his Health Minister need to bear in mind as they search for better health care outcomes in Ontario.

Their latest effort involves inviting proposals to move relatively routine surgeries from hospitals to private clinics. Most cataract surgery, hip and knee replacements are now refined enough to be done on an outpatient basis. Using the complex resources of hospital operating rooms for these fairly simple procedures means that patients with far more serious conditions are left in a very long lineup. Making it shorter means they get treated faster. Who wouldn’t want that for their aging parent, an ailing child, themself?

There are those who believe the words “private” and “health care” don’t belong in the same sentence. That if we do this we will end up like the United States where the wealthy pay for quick, top-notch treatment while those without insurance try to find a way to budget for an operation or simply opt to live – or die – with a condition they can’t afford to have fixed.

Ford has said over and over that under Ontario’s evolving system of health care, patients will only have to produce an OHIP card wherever they choose or are sent for treatment.

One can be forgiven for doubting the premier who can no longer truthfully utter the phrase, “Promise made, promise kept.” Greenbelt development, cancelling a minimum wage increase and a basic income pilot project, failing to lower auto insurance rates … the list of reversals is long.

In this case, though, given the health care mess, we must give him the benefit of the doubt on a proposal that makes sense. The public pocket will always pay private providers. Which is exactly what happens in many instances already.

About 40 per cent of health care is delivered privately, starting with your doctor whose practice is a small business. There are about half-a-dozen diagnostic imaging clinics in Thunder Bay that operate privately under the auspices of OHIP. Walk-in clinics, laboratories, Lifelabs, optometrists, pharmacies, sleep clinics, physiotherapists – they are all “private” but you don’t see placard-waving demonstrators marching outside claiming they are the death of public health care.

Moving public hospital care to private clinics is where the devil may reside in the detail if the province doesn’t insist on uniformity and build it into legislation.

What’s to stop health professionals working in our busy hospitals from being poached by for-profit surgical clinics offering better pay with lighter workloads than doctors’ OHIP schedule or the union pay scale negotiated by nurses?

Indeed, who among our valued health practitioners wouldn’t at least consider moving out of the hospital system which has been strangled of staff and resources by government cost-saving exacerbated by the COVID-19 pandemic?

Everyone’s exhausted while patients wait hours in jammed emergency rooms; months or years for an operation. The surgical backlog alone stands at 206,000 procedures. This is the system that fearful defenders want to keep? It’s a curiously Canadian conceit, as one writer put it. And it ignores the fact that in virtually every other developed nation that offers universal health care, private options are a common and uncontroversial part of the mix.

THE GOVERNMENT said this week there will be safeguards to prevent hospital staff being taken away by the new surgical centres. Organizations applying to be designated as those centres will have to show staffing plans that don’t negatively affect the publicly delivered part of the health system, which includes hospitals.

Anthony Dale, the president of the Ontario Hospital Association, is paying close attention. He knows hospitals can’t afford to lose any more staff than have already left frantic hospital environments.

Dale told The Canadian Press he is “reassured with the high-level commitment” from Ford and Health Minister Sylvia Jones that public health care won’t be compromised.

One safeguard, Dale explained, involves doctors who work in the new system having privileges at a hospital. The privileges come with rules, regulations and requirements, including laying out how and when physicians work. The privileges also carry accountability and can be revoked, Dale said.

Indeed, the province has stipulated that some doctors in the new clinics will have to remain connected to the public system through their hospital privileges. What if rare complications arise in a clinic operation that requires urgent emergency hospital care? The surgeon must be able to use the hospital OR.

Hospital surgery funding includes after-care – again by private agencies – and that presents a further way to ensure private clinic connections to public health care.

The province has already made health care innovations. A pilot project allows paramedics to treat more patients without transporting them to hospitals. Ontario has expedited the accreditation of foreign-trained nurses and this week invited doctors and nurses to move from other provinces to begin work immediately. It promises to tackle the high rates hospitals pay for “agency nurses” and has granted pharmacists permission to prescribe certain medications for common conditions. Careful expansion of surgical opportunities is a logical step.

What the government, the private sector and the public must never forget are the painful lessons learned when private long-term care homes, stripped of staff to enrich shareholders, were overwhelmed by the Covid pandemic. Terrible stories of frail, elderly patients left to die can never, ever be overlooked in the move toward a new era of Ontario public-private health care.

THE STATUS QUO is failing. That much is clear. Long wait times for treatment must be the primary concern in allowing for a wider scope of treatment options. That means no more unrealistic limits on staff numbers and hospital beds. Nurses are worth more than the stingy limits placed on their income by the Ford government. Otherwise we risk nurse walkouts as occurred in a Montreal hospital this week, or mass nurse street demonstrations as we’ve witnessed in Great Britain.

Transparency will be essential in the form of annual reports on the results of this experiment. If there is a whiff of profit-taking at the expense of medicare, a health-care ombudsman must have the ability to immediately investigate and shut down offenders.

Other provinces have gone down the private clinic path with mixed results. Ontario can learn from their mistakes.

Blind fear of new methods won’t solve our health-care crisis. Neither will money alone. Padlocked protection of medicare throughout its expansion must be built into the legislation governing what could very well fix what ails the health system we rely on for timely care. It’s care that has been delayed for too long.

Ian Pattison is retired after 50 years of award-winning journalism at The Chronicle-Journal, but still shares his thoughts on current affairs.