Ontario Premier Doug Ford’s government is preparing to significantly increase the number of surgeries performed at private, for-profit clinics.
Ford and Health Secretary Sylvia Jones plan to make an announcement next week to expand the number and scope of operations performed in independent health facilities outside hospitals, said a senior government official who spoke on condition of anonymity because they were outlining government plans.
For Ontario patients, the official says the move will result in thousands more surgeries and diagnostic procedures performed each year, an immediate way to reduce wait times for operations such as cataract removal.
Independent health facilities are clinics run by the private sector that receive public funding from the Ontario Health Insurance Plan (OHIP) to perform medically necessary procedures.
But various health professionals are concerned that the move will drain resources from publicly funded hospitals and benefit private sector clinic owners without improving patient care.
The agency that regulates doctors in the province, the College of Physicians and Surgeons of Ontario, says it has not been informed of the government’s plans to implement the changes.
Ford mentioned Shouldice Hospital in Thornhill, Ontario. as an example of a privately operated facility operating through the publicly funded system. (Sholdais Hospital/Facebook)
“Many months ago we were consulted and shared our view that stand-alone surgery centers should be connected to the hospital system to ensure continuity of care and patient safety,” college registrar Dr. Nancy Whitmore said in a statement.
“We have also shared that this is not the solution to the healthcare crisis and will further tax the shortage of human resources in our healthcare and further increase waiting times for more urgent hospital care.”
The government will consider “very carefully” to ensure the plan does not affect hospitals’ ability to retain staff, the senior official said.
“We need to do this in a way that doesn’t cannibalize existing health human resources in the hospital system,” the official said. “Independent healthcare facilities have told us they can do more within their own staff. They just don’t have the approval or the funding.”
“just dumb”
Bob Bell, former deputy minister of health in Ontario and former CEO of the University Health Network in Toronto, strongly supports performing certain surgeries outside of hospitals in purpose-built community surgical facilities.
But Bell says these facilities should be managed and operated by nonprofit hospitals, not private businesses.
Bob Bell was Ontario’s Deputy Minister of Health from 2014 to 2018. Prior to that, he was CEO of University Health Network and practiced as an orthopedic surgeon. (drbobbell.com)
“I fully agree with their desire to do more operations by moving them out of the hospital and into the community.” But moving them to a for-profit model is just stupid,” Bell said.
The Ontario Medical Association is also calling on the government to establish non-profit independent specialty surgical clinics.
CBC News asked Ford on Wednesday what his government has in mind for more private sector provision of health care.
“I don’t even like the word ‘private,’ because it’s not really,” Ford said. “No Ontarian will ever have to pay with a credit card. They will pay with their OHIP card.”
Ford pointed to the private property Shouldice Hospital in Thornhill, Ontario, north of Toronto, which performs thousands of OHIP-funded hernia surgeries annually.
“We need to have such facilities to take the burden off the hospitals,” he said.
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As for expanding the type of procedures that will be performed in private clinics, Ford said, “Simple things, not complicated. Knee replacements, hip replacements, cataracts, these are meaningless things that are lagging behind in the health care system.”
Ford did not elaborate on how such procedures contribute to Ontario’s health care problems, which include overburdened emergency rooms, burned-out staff and 1.2 million people without a family doctor.
Ford describes a conversation he had with an unnamed surgeon.
“My problem is I don’t have time for the operating room,” Ford said the surgeon told him. “And he said his boss told him, ‘Well, just go play golf,’ instead of finding another operating room.”
Bell, who practiced as an orthopedic surgeon until becoming deputy minister of health in 2014, said the barrier to surgeries in Ontario is not the availability of operating room space, but the availability of nurses.
“If you’re going to increase the amount of surgery done in independent health facilities, you need to get some nurses,” Bell said. “And guess where they’ll come from?”
Doris Greenspan. head of the Registered Nurses Association of Ontario, says providing additional nursing staff to hospitals to allow them to expand use of their existing operating facilities would be better than transferring select surgeries to private clinics. (CBC News)
Expanding the role of private clinics would take nurses away from the public hospital system, said Doris Grinspoon, CEO of the Registered Nurses Association of Ontario.
“Nursing doesn’t grow on trees,” Grinspoon said in an interview. She questioned how private clinics could perform more surgeries without hiring additional nursing staff – given the province’s ongoing nursing shortage.
Grinspoon says providing hospitals with additional nursing staff to allow them to expand the use of their existing operating facilities would be better than transferring select operations to private clinics.
“When it’s for-profit, it means someone is making money off people’s need to have surgery,” she said.
“It siphons funding from the taxpayers’ public purse [independent health facilities] to win.”
The Ford government has been laying the groundwork for expanding the role of independent health facilities for some time.
Last August, Jones said he was considering options to increase health care capacity by allowing private clinics to perform more surgeries, but offered no details.
In January 2021, the Department of Health sought applications from independent healthcare facilities to perform cataract surgery. The application document shows facilities will be paid $605 per operation.
That’s $100 to $150 more than Ontario hospitals receive from the province for the same procedure, Bell said.
The chance to do orthopedic surgeries like knee and hip replacements will be “a huge money-making opportunity,” Bell said.
“Private capital will be happy to make the necessary investments.”
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