Specialty medical clinics must be part of new health-care system
TheStar.com – opinion/editorialopinion
December 08, 2012. Francesca Grosso
In 2013 Ontario will have a new premier, possibly a new government. Ontarians should hope that Health Minister Deb Matthews’ commitment to moving certain procedures out of hospitals and into specialized clinics survives the transition. This will achieve three important goals that any government aspires to in health care: greater quality, better access and lower cost.
Clinics have come under attack since a report revealed nine of the 251 facilities providing colonoscopies, cosmetic surgery and cataracts failed quality inspections. We don’t know how hospitals would have done had they been subjected to the same quality inspection because they are not. Obviously, these results are unacceptable.
I have worked for hospitals, not-for-profit and private clinics. All charge OHIP, not patients, for insured services. Quality can be present or absent in each of these settings.
In reporting about these failed clinics, the suggestion is that procedures performed in clinics — moreover, private clinics — are more likely to lack quality than if performed in hospitals, even though they’re done by the same physicians. The arguments confuse in-hospital and out-of-hospital alternatives with the old debate of not-for-profit versus private care.
Vested interests are using this story to advance their own agendas. The Ontario Council of Hospital Unions, which commented on the story, disapproves of moving services out of hospitals. It is hard for bargaining agents to unionize in specialized clinics.
The status quo is where this advocacy ultimately leads.
Let’s consider five key points:
• Hospitals are not necessarily safe places. The landmark Baker-Norton Study in 2004 found that there were 9,250 to 23,750 preventable deaths in Canadian hospitals each year. According to the Canadian Institute of Health Information, some — though not all — hospitals have reduced this number by up to 40 per cent. This means up to 14,000 people die unnecessarily in Canadian hospitals each year, the equivalent of 45 jumbo jets crashing annually.
The Public Health Agency of Canada reports that hospital-acquired infections have risen significantly over the past five years. People who are otherwise healthy are put at greater risk in a hospital setting. If you don’t have to be in a hospital, you shouldn’t want to be.
• There is a link between quality and volume. There is no clear link between quality and ownership. Whether a clinic is not-for-profit likeKensington Health Centre or private like Shouldice Hospital doesn’t determine whether you’ll get better care. Both institutions have provided cost-effective, excellent, insured care.
International research proves that one of the most important determinants of quality is volume. Practice does make perfect. “How many of these procedures do you do?” is a more relevant question than “are you privately owned or not?” In the U.K., the National Health Service outsourced a number of insured procedures like hips and knees to specialty clinics (privately owned, for those who care). Quality studies clearly indicate that these specialty hospitals are outperforming NHS hospitals on quality and patient satisfaction on the same procedures. And costs are lower.
• Appropriate care in the appropriate setting means that hospitals should only be doing the tough stuff. We need all these settings to do what they should be doing. Hospitals are expensive places for care. They require high staffing levels and infrastructures to be able to handle almost anything. They should not be performing certain standard procedures on uncomplicated patients. These can and should be done elsewhere. Hospital advocates charge that clinics “cherry pick” the easy cases and leave hospitals with the most difficult ones. Good — that’s the idea. This will free up resources for people who really need hospital care.
• Specialized clinics will improve access. Saskatchewan Premier Brad Wall commented, “If my constituents had to choose between timeless ideology or timely health care, they would pick timely health care.”
Specialty clinics have reduced wait times for cataract surgery and cancer screening in the case of colonoscopies. We need greater access to these services. During my time working with the Ontario PC government, publicly insured but privately delivered MRIs were made available outside of hospitals. The McGuinty government converted these clinics to not-for-profits. Private or not, the result was the same: better access, lower cost.
• Specialized clinics provide cost savings. Specialty clinics perform high volumes of few procedures, which lead to greater standardization and efficiency. Real costs are far more easily identified in less complex settings where few procedure types are performed, enabling government greater control over how much it will pay for the service.
Obviously not everything can or should be done in a specialty clinic and not everybody is a candidate to have a procedure in this environment. It will require better, evidence-based quality oversight. Failure to provide quality must have severe consequences. The same type of scrutiny and consequence should also apply to hospitals.
Arguments for the status quo continue to be a barrier to the public interest — a better, safer, more cost-effective health-care system.
Francesca Grosso is a principal at Grosso McCarthy and a former policy director for the minister of health and long-term care. She is co-author ofNavigating Canada’s Health Care.
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