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In a seminal 2009 New Yorker piece, entitled ‘The Cost Conundrum,’ Dr. Atul Gawande used “the most expensive town in the most expensive country for health care in the world”—McAllen, Texas—to show that more spending and “overuse of medicine” does not equal better health care. In fact, U.S. states that spent more on health care tended to be near the bottom of national quality and patient-care rankings. Dr. Gawande suggested there is an essential conflict between the profit motive—with “physicians who see their practice primarily as a revenue stream”—and cost-effective, quality patient care.

Similarly, a robust systematic review of studies comparing health outcomes in Canada and the U.S. noted that while the Canadian model “has many well-publicized limitations. . . Canada’s single-payer system, which relies on not-for-profit delivery, achieves health outcomes that are at least equal to those in the United States at two-thirds the cost.”

As for cost, another systematic review, published in the CMAJ, looked at payments at private for-profit and private not-for-profit hospitals. Again, the not-for-profits outperformed the for-profit hospitals by costing less. Some explanations for this: For-profit hospitals are driven to generate revenue for investors and executive bonus incentives are over 20 per cent higher at for-profit hospitals. The data could also be interpreted to mean that for-profit institutions are providing superior care—but then the earlier review about mortality showed this isn’t the case.

Edmonton Journal Wed Dec 9 2015

Alberta's continuing care facilities have a patchwork of ownership models. While these facilities are all funded by public money, they are owned and operated either publicly, through Alberta Health Services and its subsidiaries (CapitalCare in Edmonton and Carewest in Calgary), or privately, by both non-profit organizations and for-profit corporations. There are issues that exist regardless of who the provider is: staffing levels are not meeting the needs of patients and continuing care is chronically underfunded in Alberta. However, fixing only those issues ignores the bigger picture.

Evidence provided by the 2013 Parkland Institute report From Bad to Worse shows that Alberta's publicly owned long-term care facilities are "significantly better than for-profit facilities" for hours of care they provide to each facility resident. This should not come as a surprise, since the primary responsibility of a for-profit corporation is to ensure adequate shareholder return on investment. These facilities are funded by government dollars, and information made public last year shows corporations expecting to make an average profit level of 27 per cent, or $5,500 per bed, per year. That money would be better spent on care for Albertans instead of being pocketed by shareholders.

Long-term care facilities (nursing homes) in British Columbia consist of a mix of for-profit, not-for-profit non-government, and not-for-profit health-region-owned establishments.  This study assesses the extent to which staffing levels have changed by facility ownership category.

From 1996 to 2006, crude mean total nursing hours per resident-day rose from 1.95 to 2.13 hours in for-profit facilities (p=0.06); from 1.99 to 2.48 hours in not-for-profit non-government facilities (p<0.001); and from 2.25 to 3.30 hours in not-for-profit health-region-owned facilities (p<0.001). The adjusted rate of increase in total nursing hours per resident-day was significantly greater in not-for-profit health-region-owned facilities.

While total nursing hours per resident-day have increased in all facility groups, the rate of increase was greater in not-for-profit facilities operated by health authorities.

Campbell River Mirror Tue Sep 15 2015

It is extremely concerning that our provincial government is contracting up to 55,000 surgeries to a private surgery clinic Re: Deal with private contractor could reduce surgery wait times - J.R. Rardon. The above noted article was in the Aug. 26, Campbell River Mirror. Reading the headline I have to ask "but at what cost?"

It is extremely concerning that our provincial government is contracting up to 55,000 surgeries to a private, for profit, surgery clinic which is yet to be built. If this company is locating in Victoria they must have received assurance for long term commitments to enable them to locate there permanently. Surgical Centres Ltd. is "based" in Calgary, they have two private, for profit, surgery clinics in Calgary, two in B.C., two in Saskatchewan. Are the owners American?

In the United States, investor-owned firms have come to dominate renal dialysis, nursing home care, inpatient psychiatric and rehabilitation facilities and health maintenance organizations (HMOs).

inroads among acute care hospitals (now owning about 13% of such facilities), as well as outpatient surgical centres, home care agencies and even hospices

The excess payments for care in private for-profit institutions were substantial: 19%.

For-profit nursing homes provide "inferior" care to seniors, and though the evidence isn't perfect it's strong enough that policy makers should pay attention, argue authors of a new paper published today in the peer-reviewed joural PLOS Medicine. The authors draw on years of research, in the U.S., Canada and elsewhere, comparing for-profit long-term residential care facilities to ones run by public bodies, or nonprofit groups. "The weight of the evidence says that for-profit delivery models provide inferior care," in terms of staffing hours, pressure sores, and other measures, says author Dr. Margaret McGregor, a Vancouver family physician and researcher with the University of B.C.'s faculty of medicine.

There is this conflict of interest between the profit motive and actually spending money on things like staffing." Past studies on the topic, which McGregor and colleagues reviewed for the current paper, have been criticized as inconclusive, because they're observational studies rather than experiments, she said. The researchers make a case that the observational data is strong enough, especially when making decisions that affect vulnerable and frail seniors. "This is a highly vulnerable population, who are not able to get up and leave if the care is poor. It's very difficult even to complain." McGregor hopes the paper spurs debate among policy makers, at a time when aging populations mean more care facilities will be needed, and the trend has been toward for-profit care in Canada and elsewhere.

In Canada, 37 per cent of nursing home beds are in for-profit facilities, compared to 78 per cent in the U.K. and 67 per cent in the U.S., according to the paper. In B.C., 34 per cent of the 292 long-term residential care facilities catering to seniors are private for-profit, according to the Office of the Seniors Advocate.

Three types of entities—nonprofit, for-profit, and government—own hospitals. Yet we know neither whether hospital types specialize in different medical services nor how service profitability affects specialization. In this econometric analysis of American Hospital Association data for every U.S. urban, acute care hospital (1988–2000), more than thirty services were categorized as relatively profitable, unprofitable, or variable. For-profits are most likely to offer relatively profitable medical services; government hospitals are most likely to offer relatively unprofitable services; nonprofits often fall in the middle. For-profits are also more responsive to changes in service profitability than the other two types

profits at the health care industry giant HCA, which controls 163 hospitals from New Hampshire to California, have soared

The big winners have been three private equity firms — including Bain Capital, co-founded by Mitt Romney, the Republican presidential candidate — that bought HCA in late 2006.

only a decade ago the company was badly shaken by a wide-ranging Medicare fraud investigation that it eventually settled for more than $1.7 billion

Health Minister Deb Matthews committed in the last election and in her recent Action Plan on Health Care to developing health-care delivery in non-profit community settings, rather than expanding the for-profit footprint in health care. Rejecting the sale of Shouldice to a publicly traded corporation is an opportunity to demonstrate that commitment.

patients, who have to pay for a hotel-style hospital stay in order to get access to its successful surgical interventions

Global Healthcare Investments and Solutions (GHIS), a venture capital firm based in the United States, is the biggest shareholder in Centric, effectively controlling the company. GHIS was founded by Dr. Jack Shevel, who grew a small South African company called Netcare into the third largest provider of for-profit health care in the world.

For-profit, or proprietary, home health agencies were banned from Medicare until 1980 but now account for a majority of the agencies that provide such services. Medicare home health costs have grown rapidly since the implementation of a risk-based prospective payment system in 2000. We analyzed recent national cost and case-mix-adjusted quality outcomes to assess the performance of for-profit and nonprofit home health agencies. For-profit agencies scored slightly but significantly worse on overall quality indicators compared to nonprofits (77.18 percent and 78.71 percent, respectively). Notably, for-profit agencies scored lower than nonprofits on the clinically important outcome “avoidance of hospitalization” (71.64 percent versus 73.53 percent). Scores on quality measures were lowest in the South, where for-profits predominate. Compared to nonprofits, proprietary agencies also had higher costs per patient ($4,827 versus $4,075), were more profitable, and had higher administrative costs. Our findings raise concerns about whether for-profit agencies should continue to be eligible for Medicare payments and about the efficiency of Medicare’s market-oriented, risk-based home care payment system.

Prairie Post West Fri Sep 23 2016

Friends of Medicare urge provincial government to legislate against private donor-paid plasma collection By Rose Sanchez Southern Alberta Officials with the Friends of Medicare and BloodWatch.org were on a five-city tour of Alberta last week, in an effort to raise awareness about private, for-profit donor-paid plasma collection in the country. Both organizations would like to see a voluntary plasma collection system in Canada done through Canadian Blood Services, and provincial and territorial governments pass legislation to ensure private, for-profit donor-paid plasma "brokers" can't set up shop. About 40 people were in attendance at the Lethbridge stop on Sept. 12, while only a half dozen made it out to the Medicine Hat meeting Sept. 13. "It's sad that we have to have this discussion after what we've learned from the tainted blood scandal of the 1980s. We need to remind Canadians the importance of what happened back then," said Sandra Azocar, executive director of the Friends of Medicare (FOM). "Blood and plasma collection must remain voluntary and public and not be contracted out to anyone else."

Earlier this year, officials with FOM caught wind that Canadian Plasma Resources (CPR) was exploring the possibility of opening private, for-profit donor-paid plasma clinics in Alberta. CPR attempted to open a clinic in Ontario a few years ago, until the provincial government there, after a strong public lobby, introduced legislation to stop it from setting up shop. Friends of Medicare officials took their concerns about this to the provincial health minister. "We've been asking since that initial meeting, for (the provincial government) to put in legislation banning the practice for paid-for-plasma clinics," said Azocar. "We all know (free) markets work well, but it does not work well in health-care ... Friends of Medicare supports a publically-regulated, not-for-profit voluntary blood collection system in Canada." Azocar said private for-profit, donor-paid plasma collection needs to be banned in provincial law across Canada, as it has already been in both Ontario and Quebec.

increased for-profit delivery has led to decreased transparency

Using for-profit laboratories increases the cost of diagnostic testing and hinders the integration of health care services

In 2012, Canadian governments will pay private corporations over a billion dollars (a conservative extrapolation from recent spending in Ontario, Manitoba, Alberta, British Columbia, and Saskatchewan)1 for medical laboratory services, making them among the most privatized of Canada’s essential medical services.

The majority of Canadians support a "mixed" model of health care that would give them the option of spending their own money for care in a private system, according to the results of a new poll.

three-quarters of them support being able to buy private health insurance for all forms of medically necessary treatment, including cancer care and heart surgery, which they could then obtain outside of the public health care system

Ipsos Reid for Postmedia News and Global Television

the unilateral Liberal cutbacks of 1995 – the greatest single cut ever to our public health care budget – had played out in service cuts and personnel shortages leading to longer waits for medical procedures

The 10-year Plan was a call for renewal.  It recommitted governments at all levels to the principles of the Canada Health Act and to making strategic improvements in 10 key areas to strengthen health care. 

The Health Council told the Committee “These accords have laudable, much needed and ambitious goals.  But have they had the broad national impact that government leaders intended?  In short, the answer is no.”

Monday, September 29, 2014

For-profit LTC beds attract fewer applicants than not-for-profit beds

Government data suggests for-profit long-term care beds are less desired by the public than not-for-profit beds.    There are long wait lists for a beds in long-term care (LTC) facilities.  (This is driven by the government's decision to add only a few new LTC beds despite the rapid growth in the number of people 85 and older, the main users of these beds.) But some LTC facilities attract longer line-ups than others.

First, for-profit hospitals don’t provide higher quality care. In fact, research shows that patients do marginally worse in the average U.S. private hospital.

In for-profit dialysis clinics, one investigation found that patients were 21 per cent more likely to die.

Second, and perhaps more important to Ontario Premier Dalton McGuinty, market reforms to U.S. Medicare haven’t saved money. Perversely, they have cost taxpayers more.

The Telegram (St. John's) Tue Jun 23 2015

With oil prices down, an aging population and high unemployment, the conservative government of Newfoundland and Labrador is looking for a silver bullet to cut costs for public services and infrastructure. Their sights are settling on privatization to be that silver bullet. What is privatization? In its most narrow sense, privatization is the whole or partial sale of public services and/or infrastructure. It can include the sale of assets, functions or the entire institution.

With privatization, the service or infrastructure becomes funded and/or run by a private corporation. Privatization usually includes not only a change in ownership but also a change in the priorities, responsibilities and role of the state. Advocates of privatization offer free-market competition as the path to economic and social success, with promises of cost savings, lower risk, greater efficiency and more individual choice. Privatization takes several forms in Canada, including:

Town & Country

Tue Nov 1 2016

The availability of long-term care beds has plummeted over the last 15 years and the number of privately-operated long-term care beds has increased while government-operated beds has decreased, according to a report published by an independent Alberta-based research network.

The US healthcare system is by far the most expensive in the world, but it now leaves about 50 million of its citizens totally without coverage and fails to provide adequate protection for millions more. And the quality of care is on average inferior to that of countries that spend much less.

No other country is as dependent on relatively unregulated private for-profit insurance plans as is the US. Other advanced countries, such as France and Switzerland, include private insurance plans as a central part of their health system, but these plans are not-for-profit and are much more tightly regulated by government than in the US.

About a quarter of all US practitioners are now employed in such groups, which are being formed by independent physician organisations and by 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.

the benefits of specialized clinics are widely accepted