Ontario’s health-care system is in crisis. More privatization isn’t the answer

Posted on June 6, 2024 in Health Delivery System

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TVO.org – Health/Politics
Jun 5, 2024.   Written by David Moscrop

OPINION: Yes, we need more facilities, and we need specialized facilities that can efficiently process procedures. But why can’t they be not-for-profit?

Doug Ford is expanding the number of private MRI and CT clinics in the province in a bid to decrease long wait times. The move has critics worried about the creeping — perhaps surging — privatization of health care in Ontario and everything that entails.

Before getting to the meat of the concerns, let’s start with the facts. The clinics will be private and for-profit, but the core, publicly listed services they’ll offer will still be paid by public health insurance — so, your health card, not your credit card (as the government is so fond of saying).

There are already seven private MRI/CT clinics in the province, so the call for new private-clinic licence applications is an expansion of privately delivered care, not a new mode of delivery.

The new clinics will be a part of the Ford government’s broader privatized health-care push, which launched last year and includes private surgery delivery and medical-imaging services. Along with scans, the new plan includes boosting the number of facilities that deliver care for hip and knee replacements, cataract surgery, colonoscopies, and endoscopies, common procedures that are backlogged throughout the province.

In 2023, when Ford announced this plan, I argued it was the wrong way to fix what is a genuine and, indeed, deadly care backlog in the province. That was true then, and it’s true now. It’s stunning but not surprising that the government hasn’t taken seriously the many critiques it’s received.

As Ford announced the MRI and CT call for licences, opposition parties cried foul, warning that the next step in the Tory health-care plan would undermine the public system and leave patients paying for care with their credit cards, not their health cards. They warned of upselling for care services and the potential for discrimination toward patients who don’t want to pony up cash for premium service.

“What we see over and over again with this opening and proliferation of privatized clinics is upselling,” said NDP leader Marit Stiles. “What are they going to tell people that they need to pay for to get to the front of the line?”

The government says they won’t allow this to happen, but we know there’s a lot of distance between what a government says in Queen’s Park and what happens at a clinic hundreds of kilometres away. Not every patient will know the rules, the best practices, or even their rights. The mere fact that private medical facilities operate to maximize profit and offer non-publicly insured services put people at risk of being exploited. Plus, no one should trust that the Ford government doesn’t have a longer-term plan to shift from public to private care. It doesn’t deserve the benefit of the doubt.

The lingering question, therefore, is why the province isn’t focusing on not-for-profit community care. If the argument here is that we need more facilities (which we do) and that we need specialized facilities that can efficiently process procedures (which we do), then why can’t these be not-for-profit, like a hospital? Why can’t they be funded by capital from the province? We’re going to pay either way: the choice is whether we pay to subsidize private profits or not.

For-profit clinics will aim to make a profit. They’ll do so through a combination of billing as much as possible, processing patients as quickly as they can, cutting corners where possible to save cash, and upselling. That doesn’t bode well for patients, does it? Ever been to a chain primary health-care clinic? Did you enjoy that experience? Where has that approach left us? Do we really want more of that?

We know that private, for-profit chains will come to dominate our health-care system if we let them. It’s already happening. That’s a recipe for poorer services, higher costs, and worse outcomes. We could achieve better results for less by removing the profit motive and focusing on community clinics run on a not-for-profit basis. I’ve yet to see a compelling argument about this approach that isn’t premised on unproven hand-waving about how the profit motive incentivizes and produces better outcomes.

The Ford government is right that something needs to change in Ontario’s health-care system. It’s right that we’re in a crisis and desperately, immediately need to speed up care and reduce wait times. But expanding privately delivered care isn’t the solution. The solution is to return to the spirit of publicly funded care and deliver as much of it as we can on a not-for-profit basis, in the community, by organizations close to their patients —instead of headed and run from a distance by some faceless, profit-maximizing firm.

David Moscrop is a politics writer and the author of Too Dumb for Democracy.


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