Ontario’s Bold Bet on Private DeliveryFebruary 27th, 2023
Ontario, like provinces across the country, are facing a crisis in their health care systems, including an ever-growing surgical backlog, days-long emergency room wait times, and an acute crisis in the provision of pediatric care.
The numbers tell a story about the challenges Ontario’s system is facing:
- 84 weeks: the current backlog for surgical procedures in Ontario
- 102%: Ontario children’s hospital ICU capacity in November – there are more children than beds available in the ICU
- 77.8%: increase in vacancies for Registered Nurses and Registered Psychiatric Nurses in the Q1 of 2022 – reaching an all time high in the healthcare sector
With healthcare concerns dominating public discourse, the Ontario government pledged to use “innovation” and act quickly to address some of these key concerns within the system. On January 16th, Premier Ford and Minister Sylvia Jones announced the government’s plan to address Ontario’s surgical and diagnostic backlog.
This plan looks to utilize community surgical and diagnostic centres in 3 steps to provide more publicly funded procedures.
First, the government will address the backlog in cataract surgeries through new partnerships with community surgical centres in Windsor, Kitchener-Waterloo and Ottawa. Secondly, the plan will expand the scope of community clinics to meet regional needs, including procedures like cataract surgeries, diagnostic imaging and colonoscopies. Finally, Minister Jones will introduce legislation to expand capacity for certain procedures within pre-existing community clinics and strengthen oversight of community surgical clinics.
Since this announcement, opposition parties have begun to decry that this is the beginning of the end of public health care. This messaging is not new and has been used by countless politicians in Canada for years. Why? Because Canada’s universal payer system is a crown jewel in the eyes of the electorate.
As a result, this new policy represents a test for the Ford Government – not only on the success of this plan, but also the strength of their messaging. The test has already begun – opposition parties are claiming that this policy is one step closer to a private-pay, two-tier system in Ontario and that private-delivery results in upselling, whereby providers attempt to push patients to pay for unnecessary services. The government is countering by responding with repetitive messaging that Ontarians will continue to pay for service with their OHIP card, not their credit card, and by pointing to other provinces where this is already successfully done.
One element that may help Ford’s case, is the federal government’s abstention from the debate. While Liberal MPPs have criticized the plan, the Prime Minister and the cabinet have stayed largely quiet and emphasized that healthcare remains a provincial responsibility. This stance is most likely motivated by the government’s ongoing negotiations with the province for a renewed healthcare agreement.
WHAT DO OTHER JURISDICTIONS DO?
In order to paint a broader picture, it is important to understand the use of private-delivery in healthcare has been prevalent across the country for some time. Many of the largest provinces across the country, including British Columbia, Saskatchewan and Quebec utilize private clinics to perform diagnostics and minor surgical procedures.
Not only is this common practice in other provinces, but private delivery has also been used by governments of all stripes in Ontario for diagnostic imaging and minor surgical procedures. In Ontario, there are over 900 Independent Health Facilities (‘IHF’), which are facilities that receive payment for the delivery of licensed publicly funded health-care services.
Private delivery is also used in the healthcare system that Ontarians are most familiar: family doctor’s offices. Doctors across the province operate as private businesses that bill the government for services provided. Thus, the cornerstone of public health for many Ontarians is also a privately delivered service.
WHAT THE GOVERNMENT IS SAYING?
“When it comes to your health, the status quo is no longer acceptable. Our government is taking bold action to reduce wait times for surgeries, all while ensuring Ontarians use their OHIP card to get the care they need, never their credit card.” – Premier Doug Ford
“Timely and convenient access to surgery and diagnostic imaging is critical to keeping people healthy. This plan will boost the availability of publicly funded health services in Ontario, ensuring that Ontarians currently waiting for specialized surgeries will have greater access to the world class care they need, where and when they need it.” – Sylvia Jones, Deputy Premier and Minister of Health
WHAT EXPERTS ARE SAYING?
“Ontario radiologists strongly welcome today’s Ontario Government announcement to take steps to significantly reduce CT, MRI, and surgical wait lists across the Province as a tangible demonstration of its patient care commitment. This priority announcement recognises that diagnostic imaging is a fundamental gateway for patients who need an early diagnosis to access surgery and other life-saving treatments.” – David Jacobs, President of the Ontario Association of Radiologists
“This is an important solution that can help address wait times, one of the biggest structural problems in the health-care system. The OMA looks forward to working with the government to implement this model of care that will expand capacity throughout the health-care system. Integrating these new centres with hospitals and the broader health-care system will help ensure high-quality care and patient safety and free up beds and operating rooms for emergency, acute and complex cases.”
– Allan O’Dette, CEO, Ontario Medical Association
“Every resident of the province should be concerned that our government is creating a two-tier system where those who can pay out of pocket will jump the queue to receive their surgery and treatment first. Nurses and healthcare workers need more support and better funding in the public system, not a plan that will simply divert public dollars into the hands of private shareholders. Nurses call on Premier Ford to abandon this disastrous plan and invest in the public system to ensure access for all.” – Bernie Robinson, RN, Interim President, Ontario Nurses’ Association
WHAT OTHERS ARE SAYING?
“I recognize we’re in a moment of crisis right now, but we need to build a stronger system for the future, and that’s where my focus is. I’m not going to comment on what [Premier Ford]’s trying to do on this one… We’re supposed to say a certain amount of innovation should be good as long as they’re abiding by the Canada Health Act.” – Prime Minister Justin Trudeau
“We want to be clear – he will not get away with this. People will end up paying out of pocket and face longer wait times in our hospitals, as his plan drives healthcare workers from our public system. At every turn, he proves that he doesn’t care about ordinary Ontarians – just making profits for his donors and friends.The Ontario NDP will use every tool available to protect our publicly funded healthcare system…” – MPP Merit Stiles, Leader of the Ontario NDP
“Doug Ford claims that families won’t have to pay out of pocket for care, but we know that families are already having to use their credit cards to access basic services. We can’t forget, this is the same Doug Ford that promised, unequivocally, he wouldn’t touch the Greenbelt, so how can Ontarians take his word on healthcare?” – MPP John Fraser, Interim Leader of the Ontario Liberal Party
With the Ontario Legislature set to resume on February 21st, the government is working on multiple fronts to get its healthcare plan into motion. Throughout the next several weeks, the government will begin preparing a consultation process to engage experts and industry professionals on the best approach to IHF expansion.
In addition, the Progressive Conservatives will need to table legislation in February to allow existing community diagnostic centres to conduct more diagnostic imaging and, starting in 2024, this legislation will also expand surgeries for hip and knee replacements. In addition, the legislation would also focus on strengthening oversight of community surgical settings. While it is likely that the government will not receive the support of the Liberals or NDP, their majority status will allow the government to pass its legislation without opposition support.
The Ontario government will also be looking to secure a deal with the federal government to provide increased healthcare transfers. As the Health Minister has indicated positive progress on the deal, experts believe the final agreement should be signed in the near future. All eyes will be on the Trudeau government, as they meet with the provinces again on February 7th.
JB+A Senior Management Team: