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Private clinics could save health system: OMA

October 2, 2011

The Ottawa Citizen 

Pauline Tam 

Specialized providers cost less, take stress off hospitals, medical association argues

OTTAWA — While Dalton McGuinty’s Liberals and Tim Hudak’s Conservatives sidestep questions about private health care, debate is stirring over a proposal to move more medical procedures out of hospitals and into specialized clinics — an idea that critics say would allow for-profit providers a greater role.

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 association, which represents 26,000 doctors, maintains its plan would save the province money, take a load off overburdened hospitals and cut wait times for patients.

“There are a lot of procedures that do not need to be done in the more expensive infrastructure of a hospital,” said Dr. Stewart Kennedy, the association’s president.

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.

A notable exception is Toronto’s Kensington Eye Institute, a not-for-profit corporation that performs cataract surgeries. The clinic, which opened in 2006 with the McGuinty government’s blessing, began doing 6,700 surgeries a year with $5 million in provincial funding. It soon increased its volume to 7,200 cases annually at no added cost.

The medical association points to both the Kensington clinic and the Shouldice Hospital as good value for money.

Critics fear the association proposal is so ill-defined that it opens the door to a greater role for profit-making providers that put the interests of shareholders ahead of patients. They also worry the clinics would lure away scarce doctors and nurses from public hospitals.

“It’s a cover for privatization,” said Natalie Mehra, executive director of the Ontario Health Coalition, a pro-medicare group.

“The (association’s) position is very ambiguous on where exactly these surgeries would be moved to, how they would be funded and who would own and operate these facilities.”

To date, neither the Grits nor Tories have endorsed the idea, although Liberal Health Minister Deb Matthews has hinted that her party is not philosophically opposed to it.

As a former Conservative finance critic, Hudak supported a 2007 proposal to outsource knee-replacement surgeries to a private Toronto hospital, even though the idea was ultimately rejected by the governing Liberals.

In this election campaign, Hudak and McGuinty have shied away from honest talk about private health care. Only the NDP’s Andrea Horwath has rejected any measures that would undermine publicly funded, not-for-profit delivery of health services.

Experts say no matter which party wins on election day, the next government will have to consider the association’s proposal seriously, if they expect to squeeze billions of dollars out of annual health spending to cope with a $16.3-billion provincial deficit.

“The politicians all know that huge, difficult decisions are coming. They just don’t want to talk to the public about it,” said Dr. Chris Carruthers, a former chief of staff at The Ottawa Hospital who now works as a health-care consultant.

Indeed, the McGuinty Liberals have already signalled their intention, if re-elected, to pay doctors and hospitals less for some publicly insured medical services. That raises the possibility that some hospitals could simply stop providing procedures with high overhead costs and low demand, resulting in more of that work being transferred to specialized clinics.

The proposal is likely to be part of the medical association’s negotiations with the government when the current wage agreement for physicians expires in April 2012.

In some ways, the benefits of specialized clinics are widely accepted. Countless studies have shown that patients receive better care when specialists perform the same procedures repeatedly and learn to do them well.

Some experts also argue that clinics don’t face the same competing priorities as hospitals, where different departments compete for limited resources, surgeries are often cancelled due to overcrowding and funding pressures lead to operating rooms being shut down.

Above all, because they concentrate on a few procedures, clinics have leaner bureaucracies and greater buying power when it comes to equipment and supplies, allowing them to treat many more patients faster and cheaper.

“In a focused environment, you can gain more efficiencies where the same dollar would buy you more health care than in large, public hospitals, which have to be all things to all people,” said Dr. William Orovan, a Hamilton urologist and outspoken supporter of private health care.

However, critics say the benefits are not as clear cut when those clinics are profit-driven companies.

For example, a 2010 study by researchers at Toronto’s Women’s College Hospital found for-profit clinics that offer colonoscopies tend to ask their patients to return for followup screenings more frequently than is medically recommended.

The resulting overtreatment not only drives up health-care costs, it also puts patients at greater risk of complications such as bowel perforations, the study concluded.

“There is a lot of evidence from the United States, where there are many for-profit providers, that patients are overtreated,” said Dr. Irfan Dhalla, a Toronto physician and board member of Canadian Doctors for Medicare. “And often, the reason for overtreatment is that there is a financial incentive to overtreat.”

Dhalla said he supports the idea of moving more procedures out of hospitals, but only if they are done in non-profit, publicly funded facilities.

© Copyright (c) The Ottawa Citizen

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