The COVID-19 pandemic was not kind to Ontario’s healthcare system. A backlog of surgical procedures is amid the myriad of healthcare issues that are becoming ever evident to the public. To address this backlog, Premier Doug Ford announced that his government would move to increase the use of for-profit private surgical clinics. With the promise that "No Ontarian will ever have to pay with a credit card. They will pay with their OHIP card."
To better understand how such for-profit surgical centers can even exist, first, consider how Canada’s healthcare system works. Canada as a nation has no national public healthcare service. Legally the provinces hold jurisdiction over healthcare, with each province and territory having its own healthcare system. The way in which the federal government contributes to healthcare is through the Canada Health Act. It outlines the way in which federal funds are transferred to the provinces for healthcare purposes, including any conditions that the provinces must abide by for this transfer to occur. Under this system, each provincial government holds a lot of power over how healthcare is handled. In this context Ontario’s government is able to promote the creation of for-profit surgical centers. Looking more broadly at Ontario's system, hospital networks are public non-profits, with private hospitals not allowed to run unless grandfathered into the current system. However, most physicians like your family doctor or local walk-in physician are independent contractors who run their own businesses but are billed through the Ontario Health Insurance Plan (OHIP).
Knowing that most physicians operate in this manner, you may wonder what’s wrong with completing surgical procedures through a similar avenue. Such a move would certainly help relieve the surgical backlog that exists. However, there is the very real danger of a “brain drain” from the public hospital system. Think about the last time you or someone you know saw a surgeon working in a non-hospital setting. You have not. By promoting the establishment of private for-profit surgical centers the province encourages surgeons in public hospitals to move towards private for-profit settings for work. With the opening of such centers you also promote the movement of other healthcare workers like nurses who are required to support surgical procedures from the public system to private centers. This worry of brain drain has been raised by several healthcare associations and organizations including the Registered Nurses' Association of Ontario.
Beyond brain drain, it is expected that the provincial government will pay private for-profit centers more for the same procedures done in public settings. For example,The Ottawa Citizen outlines how the province will pay private centers $605 for a unilateral cataract surgery usually done for $455 in the public system. So, while Canadians may not be paying for this private care using their credit card, their tax dollars will be directly used to generate profit for private interests. This is without considering the interprovince implications private surgical centers have for Canadians. Under the Canada health act physicians cannot upcharge patients for medically necessary procedures. However, if you travel to another province to receive a surgery through a private clinic, that clinic is able to charge you any amount. The CBC reported that some of these surgeries like hip replacements can cost as much as $28,000. Allowing such healthcare options to exist impacts free healthcare on a national level and further increases the development of a two-tier system.
Outpatient surgical centers in the community are not an inherently bad idea. In fact, the Ontario Medical Association has suggested the creation of such non-profit centers integrated with our current public hospital system. A study published in the BC Medical Journal looked at the effectiveness of one such outpatient surgical center. Finding that such hospital integrated non-profit centers can indeed effectively provide surgical care and reduce surgical backlog. Publicly funded and accountable outpatient centers are not the issue.
The promotion of for-profit centers is the main concern. Such centers are beholden to profit not to the public good. They further add to the Ford government’s push for healthcare privatization and try to frame healthcare not as a public service but as an opportunity for profit. Such centers indirectly increase treatment costs, further increase the shortage of healthcare workers in our public system and add to the list of governmental decisions that defy the healthcare ethos held by a majority of Canadians.
Canadians in Ontario and across the country should reject such privatization efforts. Instead, putting pressure on provincial governments to effectively invest in our public healthcare system is the best path forward. The universal and accessible nature of public healthcare should be strictly adhered to, and any attempts at introducing for-profit options to replace this system should be met with strong resistance.
By: Rvaha Affaan
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