What do clinic findings say about Ontario’s move to private health care?
TheStar.com – canada/politics
December 07, 2012. By Thomas Walkom, National Affairs Columnist
Behind the controversy over the reluctance of Ontario’s chief health-care regulator to reveal the names of 73 private medical clinics it has deemed substandard lies a far more fundamental question.
What do the quite shocking findings of the College of Physicians and Surgeons of Ontario say about the provincial government’s plan to encourage more private firms to deliver publicly funded medicare services?
The college now says it will change its own rules and reveal the names of at least the worst clinics it inspected — although a spokesperson says that won’t happen until April at the earliest.
This was always its intent, the college insists.
But lost in the dispute between business privacy and public safety is the startling fact that so many private clinics — clinics that successive governments have encouraged — simply don’t make the grade.
First, the background.
A hodge-podge of medical institutions exists in Ontario. Most hospitals are public. But there is also an array of private operations, most of them for-profit.
Some of these, such as cosmetic surgery clinics, operate outside of the Ontario Health Insurance Plan. Others — ranging from blood and X-ray labs to surgical clinics — provide services paid for by publicly funded OHIP.
During the past two decades, successive Liberal, Conservative and New Democratic Party governments have encouraged — either tacitly or openly — the growth of private medical operations.
They have done so under the belief that privately owned clinics are, by definition, more efficient than public hospitals and thus will be able to deliver publicly funded health care at a lower cost.
This is debatable. Evidence from Australia and Britain suggests that, in the end, private hospitals and clinics can be more expensive than their public counterparts.
But the other question — which governments rarely address — is whether, medically, privately delivered health care is as good as public care.
A good deal of the scientific literature indicates that it is not. A study published in the June 2007 edition of the journal Gastroenterology, for instance, looked at 331,608 Ontario colonoscopy patients over a four-year period and concluded that those who underwent the procedure at private clinics were three times more likely to have had it done improperly.
Another study, published in February 2011 by the Canadian Journal of Gastroenterology, found that about one third of colonoscopy patients who used private Ontario clinics were charged illegal user fees.
It also found that many private clinics encouraged patients to undergo repeat procedures — at public expense — well before they were needed.
Have matters much improved? I’m not sure they have.
A 2011 survey by the College of Physicians and Surgeons found that of the 104 private clinics it inspected, 48 were substandard (including three that failed outright). This year’s college survey of 251 private clinics found 73 to be substandard (including nine that failed outright).
The private clinics, if I understand their argument correctly, say they have to charge illegal user fees because they don’t get enough money from government.
That same defence is used by experts at the website Healthydebate.ca(published out of St. Michael’s Hospital) to explain why so many private clinics don’t offer adequate “quality standards.”
The experts’ solution is to have government give private clinics the same funding it awards public hospitals.
But this simply brings us back to the central, unanswered, question. Why bother at all with commercial clinics if we have to pay all of their costs (including profits) out of public funds just to stop them from gouging patients and delivering substandard care?
Why not stick with non-profit public hospitals and clinics? We know they practice good medicine. And we already pay for them.
To my mind, these are the real issues raised by the college’s latest report. If Premier Dalton McGuinty hadn’t decided to shut the legislature down, the MPPs we elected might have been able to consider them.
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