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…)
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…)
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…)
Flu season is upon us, and it seems that the for-profit-health-care bug is infecting primary and preventative care. The yearly campaign to increase the number people vaccinated against the flu is coordinated by the public sector though the Ministry of Health and Public Health Units. After that it gets a bit murky.
Large multinational pharmaceutical companies produce the vaccine. GlaxoSmithKilne Inc. is Canada’s largest supplier. Putting the vaccine in the people’s arms has been primarily done by small family practice professionals or public health nurses. To meet the challenge of increasing immunization rates – over 40% (Read more…)
It seems so obvious in hindsight: if you want to know what is going on in business-side of community medicine look where doctors look – the classified section of The Medical Post.
After reading all of the articles, during a slow day at work, a big flashy classified ad for MCI: the Doctors Office caught my attention. It is one of the expanding chains of family practice centers that are the face for-profit primary care in Canada. The ad provided no further insights into the operations of the chain.
Below this ad was a more interesting offering: the (Read more…)
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…)
With the sale of the Shouldice Clinic to a health care conglomerate it is useful to review some of the literature comparing for-profit hospitals to non-profit hospitals. The results show that:
1) there is a higher risk of death in for-profit hospitals, http://www.cmaj.ca/content/166/11/1399.full :
2) private for-profit hospitals result in higher payments for care than private not-for-profit hospitals, http://www.cmaj.ca/content/170/12/1817.full, and:
3) on average, not-for-profit nursing homes deliver higher quality care than do for-profit nursing homes, http://www.bmj.com/content/339/bmj.b2732.abstract.
These studies stand-out because of their very large sample sizes. (Read more…)
The Ontario Government has missed an opportunity with the sale of the Shouldice Clinic to health care conglomerate, Centric Health. The government could have purchased Shouldice and integrated its services into the public health care system: after all, Shouldice was funded from the public purse.
A good comparator for the missed opportunity is the Kensington Eye Centre, a stand-alone non-profit facility which specializes in eye care. It has become an example of how specialized care can be given within the public system when there is sufficient demand for similar procedures.
Shouldice was established before Medicare and, like many other
. . . → Read More: False positive: private profit in Canada’s health care: Missed Opportunity: Corporate Conglomerate Buys Shouldice Center
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
. . . → Read More: False positive: private profit in Canada’s health care: Methadone Clinic Limits Doctor’s Employment
Ontario’s recent decisions to cut fees for doctors’ services and move more services from hospitals to community facilities, called independent health facilities (IHF), raise numerous questions about doctors incomes, fee-for-service payment and for-profit clinics.
The Ontario government is arguing that they need to cut many fees because technology has changed making it less costly for doctors to perform certain services. The government wants “better value for money”. These arguments leave the impression that there is some measurable process to determine the value of medical services.
Predictably doctors are crying foul. They argue that the technologies are expensive,
. . . → Read More: False positive: private profit in Canada’s health care: Are OHIP Fees to High? – Part 1
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
. . . → Read More: False positive: private profit in Canada’s health care: More Local Lab Service Cuts
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
. . . → Read More: False positive: private profit in Canada’s health care: Independent Health Facilities and For-Profit Delivery: Reassuring Words, Troubling Results