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False positive: private profit in Canada's health care: Ontario Budget Debate Ignores Taxes and Billions Transferred to For-Profit Corporations

Ontario’s budget debate may be high profile, but it misses two essential points.

With the NDP signaling NO TAX INCREASES (on the middle class) a serious discussion about taxes, particularly the need to increase corporate and wealth taxes, will not take place. It is hard to have any serious budget discussion without considering the income side. Many commentators have made this point.

At the same time, the expanding use of for-profit companies, often multinational conglomerates, to deliver and finance public services, is being ignored. The negative impact of private delivery on cost, quality, accessibility and democratic control of public services (Read more…)

False positive: private profit in Canada's health care: Edmonton’s Medical Laboratory Proposal: A Private Insanity

I wrote the following post as an op-ed in the Edmonton Journal, October30, 2013. I hope it plays a part in halting the privatization of Edmonton’s medical laboratories.

The Alberta government is proposing to give the private sector a 15-year contract to run medical laboratory services in Edmonton. This policy meets the popular definition of insanity: a condition where you do the same thing again expecting a different result. The government proposal has been tried many times before, twice in Alberta, and it has not worked.

In 1996, premier Ralph Klein sought a private-sector provider to deliver all laboratory services (Read more…)

False positive: private profit in Canada's health care: Private Hospitals in Specialty Clinic Clothing

The provincial government’s mid-summer announcement that regulations under the Independent Health Facilities (IHF) Act will be drafted to permit “specialty clinics” raises some serious concerns. Changes in the LHINS enabling legislation will also be required. While the details are sparse the government’s stated goal is to permit the LHINs, Ontario’s regional health authorities, and Cancer Care Ontario to establish and fund clinics to provide services currently delivered in public hospitals. The government is committing that these new clinics will not harm a hospital’s ability to deliver services.

The official proposals are this general. Some best-guess inferences are: the IHF administration (Read more…)

False positive: private profit in Canada's health care: Fragmentation, Private Profit and Home Phlebotomy

Every day there are stories of how the fragmentation of health care hurts patients. A few, when a patient dies, make the media. Most often fragmentation causes small inconveniences, but there are many and they affect patients in very real ways.

December 19th’s story is about a patient with a serious chronic illness. She lives at home and manages her illness fairly well. Monitoring her condition requires weekly blood work which is taken by a home care nurse through a PIC line, a semi-permanent intravenous access port. She then walks the blood a fairly (Read more…)

False positive: private profit in Canada's health care: Quality Program Fee Increases and IHF Corporate Concentration

This year Independent Health Facilities (IHFs) in Ontario will start paying an annual administrative fee to cover the costs of their quality control program plus a new fee for the direct costs of each quality assessment. Prior to June 2012 the Ministry of Health had paid the College of Physicians and Surgeons out of Ministry funds to run the quality program.

The administrative fee per license is set at 860 dollars for the first year. The amount per license is not large but it is continuous. Many IHFs also have more than one license, for instance, they may be (Read more…)

False positive: private profit in Canada's health care: Canada Health Act used in Zombie Defence of For-Profit Health Care

Andrew Duffy, in an article syndicated by Postmedia, made the logical equivalent of mixing metaphors when he used the Canada Health Act (CHA) to legitimize the use of private clinics. The result, as with mixed metaphors, is a “head-scratching” argument in favour of Centric’s takeover of the Shouldice Clinic.

Duffy uses a confidential government manual found by Jeffery Simpson, author of a recent book on Canada’s health care system, to argue that the CHA was not intended to prohibit the use of for-profit companies to deliver essential medical services. This expose, complete with grainy pictures, is used to undermine what (Read more…)

False positive: private profit in Canada's health care: Monitoring Benefits For-Profit Health Care

A new study by the Health Care Compliance Association (HCCA) in the United States found that non-profit health care institutions are audited by Medicare more often than their for-profit counterparts: 6 times per year compared to 4 for the for-profit facilities. 47% of non-profits were also audited by more than one government agency compared to only 27% of the for-profits.

No explanation was given for these findings, but the authors found the results “surprising”. They are correct: it makes no sense. Media headlines in the last year include many reports of fraud by major drug companies, hundreds of millions of dollars

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False positive: private profit in Canada's health care: Methadone Clinic Limits Doctor’s Employment

One of Ontario’s little known private secrets is that most methadone, a staple of opiate addiction treatment, is primarily provided by for-profit clinics. Last week a doctor who works in one of these private clinics casually told me that her contract with the clinic forbade her from working for another methadone provider.

The context for the comment was that a clinic was looking for a part-time physician and she could not apply for the job. I guess her “employer” is concerned that she might steer some of her patients, and their money, to the other clinic.

This artificial barrier to

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False positive: private profit in Canada's health care: More Local Lab Service Cuts

It seems that the government is now using changes in the OHIP fee schedule give more work to the for-profit laboratory corporations. This reduction in patient access is documented by Rita Marshall in the June 22 edition of the Mitchell Advocate. Mitchell is a town in the Municipality of West Perth near Stratford Ontario.

Don’t like the fact that Mitchell Family Doctors send patients out-of-town for blood work now? Blame the province, says the office.

“Blood work is an important diagnostic tool and we were pleased to provide that service to our patients so they did not have to leave

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False positive: private profit in Canada's health care: Independent Health Facilities and For-Profit Delivery: Reassuring Words, Troubling Results

Who said these words and when?

We have three broad objectives: to develop a more community-based health care system to ensure that patients receive quality medical care as close to home as possible; that the procedures are carried out in a safe, effective manner; and to regulate facilities so that they are appropriately located and established in a planned way.

What we want to see is the freeing up of hospitals to do what they do best: provide the patient care and the patient care services that require a hospital setting. As a result, our institutions will be free to

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False positive: private profit in Canada's health care: Government Incentives Build Empires

The American Medical News reports that Fitch, a global investment rating service, found that incentives paid to hospitals for adoption of electronic health records (EHR) went to increased profits. Fitch also concluded that:

“…the hospital companies analyzed in the report are not expected to use their positive cash flow to reduce debt. They are expecting acquisitions of other hospitals to remain a top priority. Fitch could not provide specifics on expected acquisition activity, but did say that Community and HCA had the most acquisition activity in 2011.”

A paradox in free market societies, especially the United Sates, the

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False positive: private profit in Canada's health care: Medical Journal Kills For-Profit Lab Debate

I was surprised when the Canadian Medical Association Journal (CMAJ) asked me to write an analysis piece on Canada’s medical laboratories. My book, False Positive, clearly lays out my position that for-profit labs have no place in our health care system, which is at odds with the close, and profitable, relationship between the labs and many doctors. And I am a well-known critic of private health care delivery in general, a policy option that doctors have often supported.

Regardless, I was interested because an article in the CMAJ would reach a different audience than I had already

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False positive: private profit in Canada's health care: Legal Abstractions and For-Profit Delivery

The categories we use to make sense of the world structure how we act.

In his April 17th column Andre Picard, the health reporter for Toronto’s Globe and Mail newspaper, repeated one the most misleading justifications for more for-profit health care: most of the system is already private. After all, as Picard points out, many family physicians are self-employed and almost all hospitals are private, albeit non-profit, corporations. To equate public hospitals and family physicians with for-profit corporations, like Gamma-Dynacare, the Gambie Surgical Center, and the AIM Health Group, is to bury your head in legalistic sand.

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False positive: private profit in Canada's health care: Health Integration: Not in Ontario

I am sure there is a plan to improve health care. There must be: Ontario’s recent budget says it wants to improve integration, control costs and increase access. Yet Ontario’s provincial budget just does not do it.

The section heading says “Providing the right care, at the right time, in the right place”. Praise worthy sentiments. The regional governments, the LHINs, responsible for meeting this goal are going to be reformed again to increase their power. But the next point says that routine procedures in hospitals will be shifted to non-profit community based clinics.

The problem is that

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False positive: private profit in Canada's health care: Drummond and For-Profit Health Care

Considering the 1,500 dollars a day Don Drummond was paid and the research staff at his disposal you would figure that his analysis would be more subtle and better informed.

It is not news that Don Drummond supports for-profit health care but his rationale is shockingly simplistic. The following is the key paragraph from his report supporting more private health care:

There should not be an a priori or ideological bias towards public- or private-sector service delivery. Both options should be fully tested to see which provides the best service. This should not be defined simply with respect to cost, but

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