Private, for-profit clinics will play a bigger role in Ontario, to help lessen the wait-times for surgeries in the province.
The announcement was made Monday by Premier Doug Ford and Ontario Health Minister Sylvia Jones. The changes are expected to roll out in three phases and are focused on different regions. They are intended to tackle a major backlog for common procedures like cataract operations, MRI and CT imaging, and colonoscopies and endoscopies. By 2024, the government intends to roll out the third phase, which will see hip and knee replacements treated at private, for-profit clinics.
"These procedures will be non-urgent, low-risk and minimally invasive and, in addition to shortening wait times, will allow hospitals to focus their efforts and resources on more complex and high-risk surgeries," the province said in a news release.
Many on social media, including those who work in the healthcare industry, expressed their concerns.
Sara Allin is an associate professor at the Institute of Health Policy, Management and Evaluation at the University of Toronto. She says while the details around this announcement are still largely unknown, it appears independent surgical facilities, which are currently playing a marginal role, will see an expansion of capacity. If there is to be an expansion in the long term, it implies that there will be new facilities built. Allin says a big question mark surrounds how we can increase capacity, without increasing our workforce.
“We are facing a workforce shortage and crisis across Canada,” Allin tells Yahoo News Canada. “We don’t have all the workers we need for the current infrastructure, in terms of the current hospital system.”
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Allin says hospitals are well-equipped to do the bulk of complex surgeries that require overnight stays, while stand-alone facilities are well-placed to address more of the lower-complexity interventions that don’t require overnight stays.
She says the main question is how to make sure care is integrated into that system and not increase the fragmentation that the healthcare system already struggles with. The government hasn’t shared a workforce strategy indicating where workers will be needed, and how they will meet those needs.
“That strategy can help with the concerns that have been raised about where workers will come from and not attract people out of hospitals to these independent centres,” she says.
The Ford government has previously announced longterm strategies of increasing the number of seats in existing medical and nursing schools, as well as expediting the licensing of internationally trained workers. However, there hasn’t been anything announced around wage increases, which could help convince people to stay at their jobs or address issues of workers who plan to leave or retire.
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Allin wonders what the roles of hospitals will play in the future – will they partner and take on oversight of these clinics, allowing staff to be transferable? Or will the for-profit clinic work as separate independent centres that are privately owned? In that case, there needs to be efforts made to share data and workforce.
One of the issues in a crisis is being able to move people around, to be able to cooperate and collaborate in order to address surges in demand. We want to make sure we build on this learning on how to maintain a health care system in the face of shock, and not introduce new factors that can undermine the ability to act as a system.Sara Allin, Associate Professor at the Institute of Health Policy, Management and Evaluation, University of Toronto
Allin adds that there isn’t strong data to help evaluate the impacts, if any, this increase in capacity outside of hospitals have on quality and experience of care. While hospitals have well-developed data systems, facilities outside of the primary and community care sector are less developed when it comes to monitoring, measuring and managing performance.
“Are we looking at any adverse events or increase of hospital admissions after surgeries,” she asks. “We need to monitor the quality of care, just as we do in hospitals. This should be a requirement.”
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Ford and Jones emphasized that care provided at for-profit clinics will be covered by healthcare, with Ford stressing patients will "never use their credit cards". However, it’s not clear how to regulate a system that has more private, corporate components.
“What might be required to make sure there’s no additional costs placed on patients?” Allin asks. “That we’re actually enforcing the rules around no extra billings and that we’re mitigating any potential harms that might be caused by having more of a profit orientation to these corporations versus those that are more charitable and not-for-profit that are more customarily providing the care in the Canadian system.”
Nathan Stall, a geriatrician at Toronto’s Mount Sinai hospital, says having these facilities help with the backlog of procedures is a positive idea, as long as they are regulated and have good oversight.
Where he’s seeing some opposition stems from is the confusion between what’s publicly financed and publicly delivered healthcare. He says it’s important to get clarity on what’s to come in the province.
“We have to understand that a lot of our healthcare system is already privately delivered, on a not-for-profit basis, and all of it is publicly financed. We have to have that nuanced discussion and understanding so that we are all speaking the same language about what’s being proposed in Ontario or what’s going to be done.Nathan Stall, geriatrician, Toronto’s Mount Sinai hospital