Is Premier Doug Ford about to open the door wide for more and more private health care in Ontario?
That’s the fear among public health-care supporters who see growing signs that Ford will allow more for-profit health-care facilities in Ontario as part of his drive to slash government spending.
Even inside the Ontario health ministry there are mounting concerns about how to deal with the pressure being exerted on Ford by private health-care cheerleaders who insist Queen’s Park can save vast sums of money by permitting more for-profit clinics and hospitals.
These advocates, including politicians, insurance companies and conservative doctors and medical groups, are pushing hard right now because they see a perfect opening for their agenda. That’s because Ford has vowed to cut spending by 4 per cent a year. The health ministry budget is the biggest at $61 billion annually, making it the largest target for Ford.
They argue that private clinics providing diagnostic testing and minor surgeries operate more efficiently and are less costly than publicly funded hospitals. Such clinics treat private patients who want to buy their way to the front of the waiting line and patients whose treatment is covered by OHIP.
But the fact is that if Ford lets private clinics loose in Ontario we will be in real trouble, with higher costs and no real improvement in overall wait times.
Since his election, Ford has turned to private health-care advocates for key advice. He appointed Reuben Devlin, an outspoken former Tory party president and former Humber River Hospital president, to head a task force on health-care reform. He also appointed former B.C. Premier Gordon Campbell to lead an inquiry into Ontario’s finances.
Campbell is strong proponent of two-tier medicine, coming out in support recently of private B.C. clinics and their right to extra-bill patients.
What Campbell and others like him ignore is that allowing the wealthy to buy their way to the top of the queue with cash or private insurance leaves a dwindling amount of capacity for publicly funded services because there’s only so much capacity in the system. In almost every country with two-teir medicine there’s a two-tier waiting list linked to the ability to pay, not the need for care.
Earlier this month, Campbell also wrote a newspaper opinion article with former Saskatchewan premier Brad Wall in which they suggested Canada needs private clinics to deliver more health-care services. In doing so, they ignored widely available evidence that their “solution” could actually increase government costs without any increase in needed services.
Sadly, Ford may be easily swayed by these enticing, albeit misleading, statements about cheaper, faster and better services.
In truth, private clinics have little real interest in saving the government any money. Rather, they often operate in areas where there are too many inappropriate tests and procedures, doing easy tests, such as MRIs, where they can get patients on and off the table quickly, and leaving serious cases to major hospitals.
Indeed, in their drive to make a profit, private clinics offer services that may actually inflate government health costs by increasing the number of unnecessary tests and treatments.
For example, Choosing Wisely Canada, a health organization that partners with the Canadian Medical Association, suggested in a recent report that about 30 per cent of all medical services are unnecessary or inappropriate.
This is especially true with tests such as MRI scans, in particular those of the back, hip, shoulder and knee. The same is true for arthroscopy treatment for arthritis of the knee, which countless studies have shown has no real positive impact.
Across Canada, including in Ontario, health ministry officials are searching for ways to lower fees paid to hospitals, clinics and doctors for inappropriate services.
And yet private clinics, to be profitable, may well accept virtually every request from patients or family doctors for such often-elective procedures, rather than advising against them.
In the coming months, private health-care advocates will be touting their virtues and ignoring their flaws when they make their case with Ford for more clinics and even hospitals.
The pressing question now, though, is: Who will stand up for public health care in Ontario?
Bob Hepburn is a politics columnist and based in Toronto. Follow him on Twitter: @BobHepburn