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Contracting Out Hospital Work to Private Clinics – Backgrounder For years CUPE has been concerned the Ontario government would transfer public hospital surgeries and diagnostic tests to private clinics. CUPE began campaigning in earnest against this possibility some years ago with a tour of the province by British Health Secretary Frank Dobson who talked about the disastrous British experience with private surgical clinics.Unfortunately, the provincial Liberal government has now moved in this direction. The door opened a few years ago with the introduction of fee for service hospital funding (sometimes called Activities Based Funding). Then in the fall of 2013 the government announced regulatory changes to facilitate this privatization, with the government finally announcing Request for Proposals for the summer of 2014.

Hospitals are the main focus of the government’s health care cuts. They do not see community hospitals as providing a broad range of services to the local ... [Read More]population, but instead wish to remove an untold range of services from local hospitals and transfer them to specialized private clinics. The proposal would remove the most lucrative, high volume and easiest procedures from community hospitals. The remaining community hospitals would be left with the most difficult services. If they chose to compete with the private clinics, they would have to specialize in a narrow range of services. The government’s plan is the opposite of one-stop, integrated public health care. This proposed privatization of surgeries and diagnostic tests is in addition to the aggressive attempts to remove non-acute care services from hospitals (e.g. outpatient clinics, complex continuing care, rehabilitation, long-term care, primary care, etc.). As acute care currently accounts for only about 1/3 of current hospital funding, these attacks are a grave threat to the viability of community hospitals, and in fact we are now seeing a wave of hospital shut-downs that is somewhat reminiscent of the Mike Harris era. Despite the government’s rhetoric about keeping care non-profit, services that are being cut from local hospitals now are being privatized to for-profit owned corporations. Even if the private clinics did start out as non-profit (which has not been the case so far) the whole system of private clinics could be privatized with a stroke of a pen.

Ontario Health Care Privatization: The push for health care privatization in Ontario picked up in 2001 when Ontario Health Minister Tony Clement announced two privatized P3 hospital projects, the Royal Ottawa and the Brampton Civic (part of William Osler Health Centre). Spirited community-based campaigns, including P3 plebiscites in many towns, forced the Liberal government to greatly narrow the scope of the privatization of support jobs (i.e. CUPE jobs) in subsequent P3 hospitals. Nevertheless privatization of the hospital financing continues, despite revelations by the provincial Auditor General that confirmed claims by CUPE and others that the Osler project cost hundreds of millions more due to the P3.

Discussion: An overall difference of approximately three work weeks in disability duration may have meaningful clinical and quality-of-life implications for injured workers. However, minimal differences in expedited surgical wait times by private clinics versus public hospitals, and small differences in return-to-work outcomes favouring the public hospital group, suggest that a future economic evaluation of workers' compensation policies related to surgical setting is warranted.

In 2004, for example, WorkSafeBC (the workers' compensation system in British Columbia) paid almost 375% more ($3,222) for an expedited knee surgery performed in a private clinic than for a non-expedited knee procedure in a public hospital ($859) (both fees represent the aggregation of facility, surgical and anaesthetists' fees)

The Hamilton Spectator Tue Sep 15 2015

A former British health secretary is warning Ontario not to push surgeries out of hospitals and into private clinics after an effort to do the same ended with "dismal failure" in the United Kingdom. Attempts to have the private sector deliver public services has ended with abandoned contracts, increased costs, compromised care and a growing roster of consultants promoting enterprising clinics to government, Frank Dobson says. "There's a sort of huge, rather sleazy industry now that are people who worked in the National Health Service who are now running private clinics," the retired MP said during a stop in Hamilton on Monday.

Private enterprise hasn't made health care more efficient, but rather more sluggish, the longtime Labour Party politician said. Bloated corps of lawyers, accountants and consultants hired by government now fret over tenders and contracts, which must be watertight, he noted. Dobson cited one case in which a woman suffering from a serious hemorrhage bled out during surgery because the private clinic didn't have an emergency blood supply. "The answer from the clinic was the contract didn't say we had to have an emergency blood supply," he said. Dobson is touring Ontario cities with officials from the Ontario Council of Hospital Unions (OCHU) and CUPE to discourage provincial plans from bringing more surgeries and procedures into the private fray.

The Sudbury Star Wed Sep 16 2015

A former health minister from the United Kingdom says he believes "private clinics are a bad option for the people of Canada." Frank Dobson, who was health minister from 1997 to 2000 in Tony Blair's Labour Party government, made a stop in Sudbury on Tuesday. Dobson was invited by the Ontario Council of Hospital Unions (OCHU) to speak about the pitfalls of privatization of health-care services in the United Kingdom. He is visiting eight other communities in the province to give his take on health-care privatization and how it may affect the health-care system in Ontario. "I wouldn't recommend the British model to anyone because it has basically been a rip off," Dobson said.

"The money going into running the system (in Britain) has gone up from between four and six per cent of the total National Health Service spending to somewhere between 12 and 15 per cent of NHS spending going on this semi-commercial system and that is somewhere around 8 billion pounds a year extra going on the cost of running the services (that are) not going on patient care, Dobson said. Dobson also provided other examples of why the system is flawed in the Britain.

Depuis 2008, le ministère de la Santé a versé plus de 18 millions de dollars à la clinique de chirurgie Rockland MD pour opérer près de 9000 patients de l’hôpital du Sacré-Coeur. En plus, la RAMQ a dû rembourser 263 000 dollars à des patients à qui la clinique avait facturé des « forfaits santé » jugés illégaux.

« Je peux vous dire que cette entente a cours jusqu’en septembre et qu’elle ne sera pas renouvelée », a tranché le ministre

Like thousands of other Canadians struggling with obesity, the Toronto woman, helped by her mother, had paid for weight-loss surgery at a private Ontario clinic, won over by marketing that promised rapid, effortless slimming.

Within three years, though, she needed revision surgery after the restrictive band implanted around her stomach in 2008 slipped. Then she felt that fateful pop, followed by violent, breathtaking pain, and the clinic’s pledge of post-op care began to crumble, forcing her to visit two public hospitals for urgent help.

Surgeons working in taxpayer-funded hospitals across the country say they are routinely helping pick up the pieces of privately performed weight-loss operations.

Private clinics under fire for charging ‘block fees’  By Elizabeth Payne, OTTAWA CITIZENOctober 2, 2013

The closure of the Ottawa Hospital’s endoscopy clinic at its Riverside campus earlier this year — which saved the province $1 million — means private clinics are handling growing numbers of procedures such as colonoscopies,

Patients at some Ottawa endoscopy clinics are being asked to shell out $80 in block fees before undergoing medical procedures that are covered by OHIP. It’s part of a trend that, critics say, pushes ethical boundaries and violates the principles of the Canada Health Act.Natalie Mehra of the Ontario Health Coalition, a network of health activist groups, says block fees represent the “creeping introduction of user fees” into the health system, something that is increasingly common and has accelerated with the transfer of medical procedures from hospitals to private clinics.In Ottawa, the closure of the Ottawa Hospital’s endoscopy clinic at its Riverside campus earlier this year — which saved the province $1 million — means private clinics are handling growing numbers of procedures such as colonoscopies, a key cancer prevention tool. Many private clinics charge no additional fees, but at least two Ottawa clinics do.

Canada Newswire Mon Sep 29 2014

TORONTO, Sept. 29, 2014 /CNW/ - As Ontario's new Health Minister Dr. Eric Hoskins sits down with provincial and territorial Health Ministers for their fall meeting this week, experts and patient advocates hope that he'll carry a strong message. Across Canada advocates are calling on the B.C. Health Minister to hang tough on the Medicare court challenge which threatens open season on patient user fees for surgeries, diagnostics and other procedures. The case was scheduled to begin on September 8, but lawyers for both Brian Day, owner of one of the largest private clinics in Canada, and the B.C. government asked the court for a delay in order to negotiate a settlement. Negotiations are now happening behind closed doors and the court date is delayed until March 2015.

Following a provincial audit in 2012 which revealed that Day was charging hundreds of thousands of dollars in unlawful user fees to patients, Day filed a Charter Challenge to nullify the laws that he was violating. His case aims to bring down the laws that protect single-tier Medicare and forbid clinics like his from extra-billing patients and charging user fees for care that currently must be provided without charge under the public health care system. The litigation has far-reaching implications for the entire country. Day's clinics were first exposed by patients who complained they were unlawfully billed for medical procedures. The B.C. government responded by trying to audit the clinics. Day refused to let in auditors until forced by a court order, and even then the clinics did not fully comply with auditors. Auditors had access to only a portion of the clinics' billings and only one month's worth of data. Nevertheless, what they found was astonishing. In a period of about 30 days, patients were subject to almost half a million dollars in user charges. The five patients who brought the initial legal petition have had their trial delayed while Day's Charter Challenge to the laws upholding single-tier Medicare is heard. They are still waiting for redress.

Toronto Public Health, which revealed the outbreaks when pressed by the Star, said 11 patients were infected and tainted sedative injections were the “possible” cause in all cases.

By: Theresa Boyle Health, Published on Sat Sep 27 2014

Three Toronto colonoscopy clinics have had hepatitis C outbreaks since 2011, the Star has learned.

Vancouver Sun Tue Jun 2 2015

"The use of private surgical clinics within the publiclypaid and publicly-administered health care system has always been an important part of the system," he said. Of the 541,885 publicly-funded surgeries in 2013, 14, 5,503 were done in private facilities using public money. The Vancouver Island Health Authority is seeking private clinics to conduct 55,000 day surgeries over five years to ease the pressure on hospital operating rooms.

Vancouver Coastal Health said it expects to fund 350 additional surgeries, including day surgeries conducted in leased private operating rooms. Fraser Health said it would provide 500 extra procedures over the summer. "About one per cent of the surgeries done in British Columbia are actually done in private clinics but paid for publicly," said Lake, who described an "unprecedented demand" and unacceptable waiting times facing the public system. "We want to see if we can optimize that. I think patients want to have their surgeries done. If the quality is there, and it reduces wait lists and is paid for and administered by the public system, I think British Columbians would agree with that approach."

Times Colonist (Victoria) Wed Jun 10 2015

Island Health is evaluating proposals from three private clinics as it works toward contracting out up to 55,000 publicly funded day procedures over the next three to five years - the health authority's largest and longest contract yet to reduce wait times. Once the contract or contracts are awarded, Island Health could be the leader in using private clinics for publicly funded day surgeries in the province. "We're looking at doing things differently and if we're out ahead and this is a success, I hope other jurisdictions follow us," said Suzanne Germain, spokeswoman for Island Health. By the May 29 deadline, Island Health had received three responses to its April request for proposals. Island Health wants private clinics to provide up to 4,000 day surgeries - everything from knee and hernia repairs to gallbladder removals - each year over a three-to five-year contract for a maximum of 20,000 procedures. Island Health is

also looking for a private clinic or clinics to provide up to 4,000 endoscopic procedures - colonoscopies - on the south Island and up to 3,000 endoscopies in the central Island each year over the same period for a maximum of 35,000.

Toronto Star Sat Sep 27 2014

Three Toronto colonoscopy clinics have had hepatitis C outbreaks since 2011, the Star has learned. Toronto Public Health, which revealed the outbreaks when pressed by the Star, says 11 patients were infected and that tainted sedative injections were the "possible" cause in all cases. The authorities responsible for investigating the spread of infection and inspecting the clinics - TPH and the College of Physicians and Surgeons of Ontario, respectively - kept the outbreaks secret. NDP health critic France Gélinas said public awareness of the first outbreak might have prevented the next two. "It has gone beyond appalling that the same mistakes are being repeated and are not being reported," she said.

Gélinas is calling on the province to remove the CPSO as the regulator of such clinics - known as "out-of-hospital premises" - charging that the outbreaks show the organization is failing in its duties to uphold quality of care and to be transparent, and is placing patients at risk. The MPP for Nickel Belt also wants the province to suspend the downloading of hospital services into the community and place a moratorium on the creation of any new clinics until a new oversight body is created to ensure public safety. "The minister of health has to realize that this push into the community is not safe. It won't be safe until we have in place much more robust oversight," she said. Health Minister Eric Hoskins said he is seeking advice on ways to strengthen outbreak protocols and inspection programs to ensure patient safety in clinics outside of hospitals.

proposal to move more medical procedures out of hospitals and into specialized clinics

The Ontario Medical Association argues that, as the province looks for ways to curb health spending, clinics are a viable option because they can deliver many of the services currently offered in hospitals at higher volumes and lower cost.

Under the proposal, routine procedures such as colonoscopies, endoscopies, cataract surgeries and hip or knee replacements would be contracted to provincially licensed clinics that provide publicly insured medical services.Ontario has roughly 1,000 such clinics, known as “independent health facilities,” and most are private, for-profit companies. They include diagnostic specialists CML Healthcare and Toronto’s Shouldice Hospital, a boutique surgical centre that receives provincial funding to do hernia repairs.

increasing numbers of Albertans are choosing to pay for memberships at private clinics

In the four years since it opened, Copeman has seen its roster of clients willing to pay the annual charge of up to $3,900 to become patients at its Beltline facility swell from a few hundred into the thousands.

Last summer, it opened a second clinic in Edmonton.

The Globe's health care panel looks at the state of Canada's health care system and discusses the role private clinics can play within Medicare.

over the last decade health care spending has shrunk as a percentage of total program spending, down from 46 per cent to 42 per cent while Ontario’s population increased.  In the same period payments to physicians have increased by 88 per cent and drug costs doubled in the last 20 years.

during an Ottawa Citizen live broadcast session health minister Deb Matthews “is effusive about the convenience of private dialysis clinics operating in strip malls and assembly-line eye clinic operations,” says Hurley.

In the current system, routine patient surgeries effectively subsidize costlier care for complex patients. Private clinics will skim the least complicated and low-cost patients but likely they will receive the same funding as hospitals that will treat the more complex, high-needs patients.

A Regulation under the Independent Health Facilities Act - Prescribed Persons Ministry: Ministry of Health and Long-Term Care

The Ministry of Health and Long-Term Care (Ministry) is proceeding to establish community-based specialty clinics as per Ontario's January 2012 Action Plan for Health Care. Shifting low-risk ambulatory services from a hospital to a community-based setting represents an opportunity to improve access and the patient experience, maintain quality and outcomes of services, and realize reductions in costs for routine services currently performed in a hospital setting.

August 12, 2013

Toronto Star Tue Sep 23 2014

Patients profiled by the Star said no one volunteered to them they were infected at the clinic - not the Rothbart clinic, not James, not Toronto Public Health (TPH), which investigated the outbreak, and not the College of Physicians and Surgeons of Ontario (CPSO), which has regulatory oversight of such clinics, known as "out-of-hospital" premises. The TPH investigation included an infection-control audit, done in conjunction with Public Health Ontario. It found 170 deficiencies, including improperly sterilized equipment. TPH has never made the results of its investigation public. The CPSO inspected the clinic a number of times after the outbreak. Its online register shows it gave the clinic "conditional" passes for three inspections, with conditions related to improving infection control. But there is no mention on the CPSO website there was an outbreak, infection-control breaches or people were made ill. Gelinas said she is "really, really worried" that the province is moving services out of hospitals and into clinics that do not have the same level of oversight and accountability.

Health Minister Eric Hoskins said in a written statement that improving transparency in the health system is a top priority. He noted that the CPSO last year amended a bylaw allowing details of inspection outcomes to be posted on its website. Kacho only learned on Saturday evening that her meningitis was linked to her treatment at the clinic. That's when she said she got a "shocking" phone call from a TPH official. TPH has been trying to reach the nine patients infected since Friday, the day before the Star article appeared. "We are in the process of contacting these individuals as a courtesy and to ensure transparency. Our goal is to ensure that patients were aware that an investigation that they were part of was likely going to be profiled by a media outlet," TPH spokesperson Lenore Bromley said. TPH earlier this month told the Star that the infected patients had been contacted during the outbreak, at which time they were informed of the investigation into the clinic and told there had been breaches in infection control.

The Globe and Mail Sat May 23 2015

It's 4:30 on a Friday afternoon at her Sherbrooke, Que., clinic and Marie Hayes takes a deep breath before opening the door to her final patient of the day, who has arrived without an appointment. The 32-year-old mother immediately lists her complaints: She feels dizzy. She has abdominal pain. "It is always physical and always catastrophic," Dr. Hayes will later tell me. In the exam room, she runs through the standard checkup, pressing on the patient's abdomen, recording her symptoms, just as she has done almost every week for months. "There's something wrong with me," the patient says, with a look of panic. Dr. Hayes tries to reassure her, to no avail. In any case, the doctor has already reached her diagnosis: severe anxiety. Dr. Hayes prescribed medication during a previous visit, but the woman stopped taking it after two days because it made her nauseated and dizzy. She needs structured psychotherapy - a licensed therapist trained to bring her anxiety under control. But the wait list for public care is about a year, says Dr. Hayes, and the patient can't afford the cost of private sessions.

Meanwhile, the woman is paying a steep personal price: At home, she says, she spends most days in bed. She is managing to care for her two young children - for now - but her husband also suffers from anxiety, and the situation is far from ideal. Dr. Hayes does her best, spending a full hour trying to calm her down, and the woman is less agitated when she leaves. But the doctor knows she will be back next week. And that their meeting will go much the same as it did today. In its broad strokes, this is a scene that repeats itself in thousands of doctors' offices every day, right across the country. It is part and parcel of a system that denies patients the best scientific-based care, and comes with a massive price tag, to the economy, families and the health care system. Canadian physicians bill provincial governments $1-billion a year for "counselling and psychotherapy" - one third of which goes to family doctors - a service many of them acknowledge they are not best suited to provide, and that doesn't come close to covering patient need. Meanwhile, psychologists and social workers are largely left out of the publicly funded health-care system, their expertise available only to Canadians with the resources to pay for them.