The province’s plan to allow private clinics to perform more procedures has the potential to help reduce Ontario’s surgery backlog, experts say, but the details of the plan will be tight-lipped.
“I think there are some outstanding questions based on the announcement from the government,” said Dr. Fahad Razak, former chair of the Ontario COVID-19 Scientific Panel and an internist at St. Michael” to CTV News Toronto.
“There is no doubt that the problem is significant. It’s driven both by the existing capacity constraints, (which) have now become much, much worse because of the pandemic and the repeated waves of the pandemic. So it was important to do something.
“The question is, what is the best approach to deal with this problem?”
There’s no doubt that Ontario’s health care system has been hit hard by the COVID-19 pandemic. Emergency and intensive care units were regularly over capacity, and the constant spread of the novel coronavirus meant staff had to struggle with their own numbers to cope.
Doctors who normally worked in surgical wards were reassigned to general or emergency care. All non-urgent procedures were postponed, creating a huge backlog of patients.
In an effort to help deal with the growing waiting list, Premier Doug Ford announced a three-step plan Monday to give private health clinics more responsibility. This includes expanding cataract surgery, MRI and CT scans, minimally invasive gynecological surgeries, and possibly knee and hip replacements.
“We have great hospitals working hand-in-hand with the clinics, and that’s the way we’re going to work, excuse the pun,” Ford told reporters at the time.
“That’s how we’re going to move forward with this.”
The idea was met with immediate criticism from health unions and opposition leaders, many of whom argued the investment would push staff away from hospitals where they are needed most. They also warned that for-profit clinics may try to sell patients higher prices or charge them for other overhead costs.
But some experts say it can work as long as there is a staffing plan and clear oversight of how the funding will be provided.
“The idea of bringing many of these surgical and other procedures into different specialty clinics is not a bad idea. In fact, other countries have actually been doing this for several years,” Doug Angus, professor emeritus at the Telfer School of Management at the University of Ottawa.
Angus is a specialist in health economics and points to Sweden, where private clinics receive public funding to meet the needs of the population, as an example of how this system can work.
At the same time, he said, expectations for these clinics should be transparently laid out and enforced. In order to be reimbursed for services, private clinics—especially for-profit facilities—must meet certain quality standards and conditions.
“I think the government’s role here needs to be upfront and clear so that private clinics understand the rules of the game.”
Razak echoed that sentiment and said there should be “very strict controls” before private clinics start offering these additional services. This information and related data, he added, should be publicly available.
He also questioned why the program should be permanent if the goal was expressly to clear the backlog.
The province said about 206,000 people in Ontario are waiting for surgical procedures.
In terms of wait times, patients who need cataract surgery wait an average of 67 to 124 days for the procedure after making a decision with their doctors, according to provincial data, depending on the urgency of their case.
For knee replacements, patients in Ontario wait an average of 133 to 168 days for their surgeries, while the wait for a hip replacement averages between 127 and 159 days.
WILL THIS LEAD TO MORE PRIVITIZATION?
Ontario already has a two-tier health care system. Although most services are covered by the Ontario Health Insurance Plan (OHIP), there are many other services that are not, including dental exams and prescription drugs.
As such, doctors, says Angus, have always been thought of as “private sector entrepreneurs” and this is no different.
“A lot of people providing health care services are already private,” he said. “If you go for lab tests and radiology tests and things of that nature, you usually go to a private clinic where you just present your OHIP card and get the blood tests or radiology tests that you need, and the private clinic gets reimbursed.”
“It’s not an entirely new concept.”
Experts say the concern is particularly for for-profit clinics.
“The promise (as of Monday) was that the OHIP codes would remain the same for these private facilities versus public facilities,” Razak said. “Where does the money come from? How does an investor recoup costs, recoup their investment? That’s where the worry is.”
That’s where strong oversight will come into play, and why some say the province should have limited its investment to private, for-profit clinics.
Multiple people have expressed concern that clinics like these may be able to upsell — offer better quality products at higher prices — or charge for things like room use, medications or follow-up care.
“The question, I would say, is why do you want profit here,” Raisa Deber, a professor at the University of Toronto’s Institute for Health Policy Management and Evaluation, told CTV News Toronto.
“I’ve never seen any evidence to say it’s good value for money. In fact, places that allow it end up spending more money for worse results.
Deber adds that some patients may be persuaded to get procedures they either don’t need or aren’t considered essential.
Asked about the fees on Monday, Health Minister Sylvia Jones said there were “a number of different pay structures” and that as such the question was challenging to answer.
“HUMAN RESOURCES SHORTAGE”
Health workers’ unions said the plan would affect future bargaining and foresee another mass exodus of staff to the private sector as they may gravitate to clinics with better pay and working conditions.
“The idea is good, but there is still a huge lack of human resources to be able to somehow deliver this,” Angus said, adding that hospitals would be left in a “more difficult position than they are now”.
The Ministry of Health insisted that this would not happen. The prime minister said earlier that around 60,000 nurses had been recruited since 2018, including a recent commitment to bring 6,000 more frontline workers into the health system.
“We’re doing a lot of different things to make sure we have enough health human resources across our sector,” Jones said Monday, further touting her government’s plan to fast-track licensing for internationally educated workers.
Little more information was provided about where the new staff would come from, but Jones said any new clinic would have to provide a human resources plan.
“There’s no plan that I’ve heard described so far as to where the staff for these private facilities will come from,” Razak said. “And the concern, and I think it’s a valid concern, is that the staff will come by draining some of the stuff from the public system, which is already very understaffed.”
Instead, Razak said it would be ideal to invest additional resources into the province’s existing system, hiring more staff and allowing operations to take place outside the usual nine-to-five hours.
“Why not take the existing operating rooms within the hospitals, the hundreds of hospitals across the province that have those operating rooms, and maximize the use of those operating rooms to catch up?”
Leslie Boyer, a professor at the University of Toronto who specializes in the privatization of surgery, feels the same way. He said while the use of private clinics elsewhere in Canada and around the world is working well, Ontario must remain focused on making sure its public system works well.
“The public system is designed to provide a service,” he said. “The private system you can’t get out of wants to make a profit. For me, the first goal should be service to the Canadian people.
“We must be able to step back at some point and stop jumping from crisis to crisis. And I would say we need to start making some fundamental decisions about what we want from health care in Canada?”
The Ontario government said it hopes to roll out its new partnerships with private clinics by March 2023.
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