Shifting to clinics is right prescription for Ontario

Posted on January 20, 2013 in Health Delivery System – opinion/editorials
January 18, 2013.

It makes medical and economic sense to move routine procedures from hospitals to not-for-profit clinics. Patients get served faster in a less stressful environment, at lower cost. Best of all, studies have shown the results are as good or better.

Ontario Health Minister Deb Matthews began the de-hospitalization processa year ago and added four more low-risk procedures — colonoscopies, dialysis, MRI scans and hip and knee surgery — this week. These services will be delivered by specialized medical professionals. They will be covered by OHIP.
“It has been demonstrated that specialized clinics, which focus on a select few procedures, can serve more patients, more quickly, with excellent patient outcomes,” Matthews told the Canadian Club of Toronto. “That means less time spent waiting by patients, and more convenience for them.
”Provided clinics meet the same standards of patient care and public accountability as hospitals, this is a welcome move.
The success of the Kensington Clinic, which specializes in vision care (cornea transplants and cataract removal), showed that costs could be reduced without compromising care.  Matthews also announced the opening of two midwife-led birth centres. Long before these reforms — 67 years ago, in fact — the Shouldice Hospital in Thornhill, which specializes in hernia repair, established the benefits of single-purpose medical facilities.
For years, the pressure from medical experts to decentralize Ontario’s hospital-based health-care system had been building. After the 2011 provincial election, Matthews summoned up the will to do it. The health-care budget had ballooned to $47 billion. She had to rein in costs.
Wisely, however, she chose not to follow the experts’ advice blindly. She drafted a step-by-step plan, giving herself time to ensure that patient care improved before proceeding.
The minister, like millions of Ontarians, learned the folly of letting “experts” overhaul medicare a decade ago.
In 1996, former premier Mike Harris entrusted the restructuring of Ontario’s health-care system to an independent commission headed by Duncan Sinclair, dean of medicine at Queen’s University. The panel delivered its blueprint four years later, then proceeded to turn the system inside-out, closing small hospitals (such as Wellesley) or downgrading them to ambulatory care centres (Women’s College). They amalgamated the rest into mega-hospitals. The transformation was expensive, divisive and disruptive. In the end, it didn’t deliver what Sinclair promised: a seamless, integrated health-care system.
Now — again at the behest of experts — Matthews is recreating the old model of medical boutiques, but replacing small hospitals with specialized clinics. What’s different this time is that she is not relinquishing control to unelected officials or introducing changes without proof that they improve patient care. This week’s announcement reflected that approach. It was modest in scale and backed up by credible evidence.
The minister’s “action plan” is only a year old. But so far it is delivering what she promised: high-quality care for a lower price.
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