The acting editor of the CMAJ has sparked a controversy weighing in to a debate about parking, suggesting that parking near health facilities should be subsidized. Assuming such a policy can be operationalized (how near? For whom?), the underlying issue is an interesting and global one. When I was first appointed as a Board chair in Australia the CEO wanted me to fix two issues: parking and the squeezing out of elective surgery by urgent cases.
In Alberta, there’s a provincial regulation which has been interpreted as precluding subsidy of ‘ancillary services’ such as parking. But should this be so? Is parking a health service? I’m not sure. Should we subsidize public transit fares for those that don’t drive to an appointment, to visit a relative or to work in the facility?
The issue is clearer in Alberta where we negotiated a five year funding deal with the provincial government. The budget is known for the next few years. If the government decides to change the regulation then it has two choices: either tell Alberta Health Services to absorb the costs and cut other aspects of health provision to find the money, or the provincial government could allocate extra money to the health portfolio. Somehow I think the latter won’t happen.
So it all comes down to a priority choice: if parking is a health service, how many hip replacements (or other health services) is it worth?
A final note, is that part of the Alberta Health Services’ strategy on parking was to publish an annual statement of how much we got in from parking revenue and how much we spent on parking. This was part of our commitment to transparency. We also found it easier if people could see that we didn’t make a profit on parking!
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The problem is not that parking is a cost, but that the parking garage operators around hospitals — Health Sciences Centre in Winnipeg is a good example — charge rates greatly in excess of those charged anywhere else, including downtown. Now this is supply and demand at its finest, granted. Parking around the hospital is limited and there’s really only one supplier in the game outside the entrances to the ER wards (childrens and adults). So should people pay for parking? Yes. Should there be predatory rates for captive market? I leave you to answer this one yourself.
I think hospital parking is a bigger problem for small towns that lack public transit than cities.
there should be no doubt about the need to pay for parking
at Toronto Area Hospitals..it should be abolished..imo..may also reserve
the right too change my mind..Merry Christmas…
Thank you Stephen for your take on this issue of parking costs as a barrier to health care.
As a physician who is responsible for patients admitted to hospital, I see first hand the positive impact on my patients health that family, loved ones, and advocates can have.
Rather than charge parking to visitors (and staff), should we not recognize their contribution to improving healthcare efficiency? Though I cannot cite any studies of the top of my head, I have >10,000 hours “in the healthcare trenches” that has convinced me that patients who have loved ones involved in their care have better health outcomes. In many cases, the family ease the workload of nurses and facilitate communication with the patient and their community care team. They are essential members of the patients team.
As to how many hip replacements would be delayed, I can only speak as a physician responsible to my own patients. However, my research (mainly with patients and front line staff, but also with health policy experts and economists) indicates that it is never acceptable to disregard the suffering of an individual in front of you for a hypothetical obligation in the future.
That fixed budgets and fiscal restraints are current realities is not lost on me. Until my healthcare system and hospital are able to address this, I have decided to adopt a policy of reimbursing the hospital parking expenses of my patients or their family who feel it is a barrier to their health.