Hospital parking: health care’s controversial cost
Shalimar Novak is sick of paying for parking. The social worker has been to Toronto’s Mount Sinai once or twice a week recently for appointments related to her pregnancy, and paid about $15 every time. “It definitely adds up,” she says. “And when you have a kid coming, you’re thinking in diaper dollars. It would be nice if that money could go towards things you need, instead of going towards parking.”
She and her husband have decided they’ll probably take a taxi to the hospital when she goes into labour, rather than dealing with the hassle and cost of days of parking.
Mount Sinai doesn’t have its own parking. Patients and staff park at nearby lots run by private companies or by the city. But the costs in hospital-run lots aren’t much different.
At the nearby Hospital for Sick Children, visitors pay up to $20 a day, and parents can buy monthly passes for $200. That cost of up to $2,400 a year – or more, if two parents need to park – is a strain on families, says Susan Kuczynski, parent liaison for Ontario Parents Advocating for Children with Cancer. She’d like to see more accommodation for parents. “I understand the visitor having to pay the rate – that’s a choice. As a parent, you don’t have a choice,” she says.
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The issue is large enough that the Ontario government recently promised to cap or cut hospital parking fees. But at the same time, cash-strapped hospitals have grown dependent on the revenue parking provides. And it’s not just a question of fees: some hospitals struggle to make sure their lots have space for patient and visitor parking by doing things like shuttling staff in from off-site parking locations. Still others offer patient-centred services, like valet parking. So what’s working – and what’s not – in hospital parking lots?
The high cost of hospital parking
Hospital parking fees for patients range from free at some rural locations to more than $20 a day in downtown Toronto. Hamilton Health Sciences and Hamilton’s St. Joseph’s Healthcare recently announced a 25% rate hike to $25. And tickets for infractions at metered lots can run $30 or even $80.
These rising hospital parking fees inspired an Ontario Liberal election campaign pledge around parking costs, which Health Minister Eric Hoskins promised to follow through with in July. The platform included a promise to “work with hospitals to cap or cut parking fees for those who must visit the hospital frequently, either due to a medical condition or to regularly visit a loved one.”
The Ministry of Health and Long-Term Care didn’t answer questions about the specifics of the program. Samantha Grant, spokesperson for the ministry, did offer this statement on the plan: “Our government is going to bring in a realistic plan to help Ontarians with their living costs today as it pertains to hospital parking fees. This is a priority for our government and the Minister has been actively involved in engaging the ministry to come up with a reasonable plan and recommendations on the best way forward.” In January, the federal government also announced there would no longer be GST/HST on hospital parking, though it’s not clear if those savings will be passed on to patients.
A Canadian Medical Association Journal editorial addressed parking fees in 2011. “Parking fees amount to a user fee in disguise and flout the health policy objective of the Canada Health Act. … This is parking-centred health care, which is not compatible with patient-centred health care,” wrote interim editor-in-chief Rajendra Kale.
He also cited Scotland, which got rid of most hospital parking fees in 2008. The government saw it as a matter of principle, arguing that hospital parking fees went against the idea of free health care, as well as being a source of stress for patients.
That’s the issue for Canada as well, says Stephen Duckett, ex-Alberta Health Services president who now works at Australia’s Grattan Institute. He believes hospitals should aim to break even on parking costs, but that they’re not a user fee. “It comes down to the question, do you think parking to get to a hospital appointment is a health service?” he says. “I’m inclined to say it’s not. If people think parking is a health service, what about the gas to get to the parking? Is that a health service as well?”
Vicki McKenna, vice-president of the Ontario Nurses’ Association, argues it is essentially a user fee. Parking costs make people think twice about visiting patients, she says, and she’s heard of patients scheduling appointments for when their pension cheques comes in. “Some people will ration their health care, really, [because of parking fees],” she says. “It’s unmanageable for many people, particularly those on fixed incomes. And even for those that aren’t, they struggle to pay it.”
Some hospitals, including SickKids, have discretionary funds that help people with very limited means with expenses like parking, public transit or meals.
In Ontario, the funds that come from parking have become more dear as hospitals have faced 0% base operating funding increases from the government. “Hospitals do their best to provide parking solutions that not only work well for patients and visitors, but also for the organization’s operational needs,” the The Ontario Hospital Association said in a statement.
Northumberland Hills Hospital in Cobourg nets about $500,000 a year from parking. “For a hospital our size, that’s the equivalent of a program,” says Jennifer Gillard, communications director. But charging for parking can also be more challenging in small communities, since people are used to parking elsewhere for free.
The Ottawa Hospital, in contrast, brought in $17.3 million from parking in 2013/14, which gave them a surplus of $12.6 million after the lot’s $4.7 million of expenses. That surplus, which is 1.2% of their total operating budget of $1.05 billion, goes towards medical equipment. “It’s a little bit of a selling feature; it helps ease the pain,” says Richard Wilson, the hospital’s CFO. He points out that the government doesn’t help fund parking lots, and that hospital budgets are tight. “As a CFO of course I enjoy the money, and we need it to provide the care that we do. Having said that, I wish we could provide free parking, because patients see it as a user fee, disguised,” he says.
Some Ontario hospitals run their lots themselves, while others outsource the task to private firms. After costs, the revenue from hospital parking is always reinvested in patient care, according to the Ontario Hospital Association.
In Alberta, parking rates are also rising. Alberta Health Services began a three-year plan to raise rates last year, which will eventually bring in an extra $7 million annually across the province. In 2013/14, hospitals across Alberta garnered over $71 million from parking. (Charges are set based on a market-rate analysis.) Funds are not funneled to patient care; rather, they’re used to cover the parking facilities’ operating costs, maintenance and upgrades, as well as construction of new lots. Any excess goes towards a reserve fund for repairing lots and building new ones. And unlike in Ontario, private companies are not involved, beyond services, like snow removal, that are contracted out.
Finding spots & patient-centred parking
Many hospitals are also trying to manage lots that are often full. Sudbury recently voted to approve Health Sciences North buying land for nearly 1,000 more parking spots. The hospital currently shuttles some employees from off-site locations in an attempt to avoid full lots. The Ottawa Hospital does the same, renting lots from other locations across the city. Employees are even on waiting lists for parking. “We get more complaints [from patients] about access to parking than about cost,” says Wilson.
Others are focusing on the patient experience. Sunnybrook has a valet service, where for an extra $3, patients can leave their car at the door from 9 a.m.-5 p.m. on weekdays. The service, which is free for elderly customers or those with a disability permit, started in 2006. It’s now used by about 30-40 people a day, with busy days getting up to 100. It was created in response to a parking shortage, but has been carried forward because of its popularity.
The Ottawa Hospital recently introduced a similar program, where “blue-tie ambassadors” help patients out of their cars at the door, leaving drivers free to find parking. It was inspired by a patient complaint.
Cathleen Bryden wrote to the hospital’s CEO, Jack Kitts, after a demoralizing experience with a malfunctioning parking pass and an unhelpful security guard. She had to leave her husband, nauseous from treatments for advanced bone cancer, by a parking machine as she ran across campus to get a new pass from an office in another building.
That became part of a broader discussion about hospital parking that included the hospital shadowing Bryden and her husband one day, which highlighted another issue. Caregivers like Bryden were driving up to the building, parking illegally, finding a wheelchair, loading their loved ones into it, finding a spot for them inside the doors and leaving them there while they parked – a stressful start to appointments. The hospital now has the ambassadors at three of its campuses, as well as the cancer centre. “It’s key because you’re already often in a rush,” says Bryden. “And it’s very hard psychologically to take those first steps every day … my husband had to brace himself every time.”
Having a friendly greeting and some help can make a big difference, says Bryden. After all, “this is the first experience patients have with the hospital.”