As we breathe a tentative sigh of relief that COVID-19 numbers are stabilizing, the ripple effects of the pandemic are becoming more apparent.
Thousands of surgical procedures were cancelled when hospitals adjusted operations to brace for the wave of COVID-19 patients. Now, as governments grapple with this backlog, some have announced their intention to contract out care to private for-profit investor-owned facilities.
British Columbia is using all available beds to address its backlog. This now includes contracting out publicly funded care to for-profit surgical centres such as False Creek Surgical Centre, owned by Kensington Capital Advisers, a private equity firm. Manitoba recently announced that it, too, is considering contracting with for-profit facilities to address its backlog, as has Alberta with its recently announced Bill 30.
There is no doubt that COVID-19 has demanded healthcare systems adapt quickly, without the benefit of the long-term planning usually required for systems change. In the case of surgical backlogs, we should treat an acute wait list problem differently than we treat a chronic one. We must, however, ensure that short-term fixes don’t cause long-term harms – and that they ideally benefit the system.
Investor-owned, for-profit facilities may seem like an obvious solution to COVID-19 surgical backlogs. But what does previous experience tell us about these facilities?
Care delivered in for-profit facilities costs more than not-for-profit care and mortality and morbidity are worse. Past contracts in Alberta have paid higher prices to for-profit facilities than to public hospitals for the same services. Death rates from COVID-19 have been dramatically higher in for-profit long-term care facilities than in publicly owned or not-for-profit homes; in eastern Ontario, 83% of long-term care deaths occurred in for-profit homes. Why this discrepancy? Because investor-owned facilities owe a fiduciary responsibility to earn money for their shareholders, meaning less money is available for patient care. This must not be the way forward for our healthcare system.
So how do we create lasting capacity within the public system beyond the current crisis? Our response must be rooted in the solid evidence about system reform.
To clear the surgical backlog, we must scale-up hospital capacity by extending operating hours to include evenings and weekends. We should immediately implement team-based single-entry centralized wait-lists for the first available surgeon so patients can access care as quickly as possible. This approach has dramatically improved surgery wait times. “Surgical smoothing” would separate planned and unplanned surgeries into different operating room streams, eliminating the problem of emergencies bumping other surgeries. We must scale-up cost-effective, not-for-profit, publicly funded ambulatory surgical centres, such as rural and satellite sites, managed by hospitals.
In the short-term, if governments insist on using private investor-owned facilities in addition to, or instead of, exploring not-for-profit and public solutions, what are some critical elements that must be in place to minimize undermining the rest of our healthcare system?
First, provinces should only be turning to for-profit facilities after exhausting all efforts to increase capacity in the existing not-for-profit infrastructure. Where such for-profit facilities exist, government should consider purchasing them and bringing them under public ownership as B.C. did when it recently bought two private MRI facilities.
Second, any contracting out to investor-owned facilities must not delay or undermine initiatives to expand access to care within the public or private not-for-profit system (such as B.C.’s surgical strategy announced in 2018). Nor should new investor-owned facilities be built to address this pandemic-induced short-term backlog. This is the time to invest in our public health care system, not in a profit-driven industry.
Third, we must have full public oversight of investor-owned facilities. Governments must ensure they are transparent, operate within the law, and are subject to the same standards of inspection and certification as not-for-profit hospitals. This means not charging patients extra fees or selectively “cream skimming” healthier patients whose treatments cost less as a way to increase corporate profits. It means ensuring that proper personal protective equipment and infection control practices are in place.
We have a once-in-a-generation opportunity to learn from this pandemic and improve our healthcare system. We need to come out of this crisis with a stronger, more equitable public healthcare system, not a more fractured one.
As we recover from this crisis, we should be working toward a future that always puts patients above profits. If this crisis is instead used as an opportunity to expand and entrench for-profit investor-owned delivery of health services, it will be at our peril.
The comments section is closed.
I absolutely agree with you. One of the problems is that mdical personnel are educated with a large input of public funds. The number of trained professionals is limited. If many are lured to work for the private system who can afford to charge more, they will disproportionately service those with greater means, and leaving the public system to serve the less fortunate, with fewer staff. This will inevitably lead to a two-tiered health system.
Excellent point Muriel. And why choose a long term/infrastructure type solution to a short term problem. There is another agenda indeed. As Nikos – let’s be smarter than our neighbor below and stick with our society’s vision of fundamental right to medical care for all regardless of your income.
I absolutely agree with you. One of the problems is that mdical personnel are educated with a large input of public funds. The number of trained professionals is limited. If many are lured to work for the private system who can afford to charge more, they will disproportionately service those with greater means, and leaving the public system to serve the less fortunate, with fewer staff. This will inevitably lead to a two-tiered health system.
Thank you for this excellent article. I did my part and posted on my FB page and send it as an email to friends.
I hate to see our public health care system slowly eroded by conservative/republican type efforts and make it look like that huge mess south of the border. In the US the insurance companies have made billions during the pandemic by collecting premiums but not actually spending on any treatments because people are afraid to go to the doctor or the hospital.
https://www.theguardian.com/us-news/2020/aug/14/us-health-insurers-coronavirus-pandemic-profit
Nikos- agreed. I added a comment – not sure if they will posted .
Canadian medical centers and Canadian University Health Centers are politically heavy and they have a poor understanding of the financial / operational realities of the peri-operative event. This event begins when a person is alerted by a health problem and ends when his health problem is resolved. It is not a simple event or an inexpensive one. However, a well managed peri-operative event is significantly less costly than a badly managed one.
For decades now, the debates have been about public vs private. Wash, rinse, repeat – obviously, this is not the debate – if it were we would not be in the situation that we are in, the one that looks the same or worse as the one Canadians were in, in 1991. Neither public or private surgery centers will excel at comprehensive, accessible and sustainable peri-operative care without mastering the market.
It is time that Canadians discussed the surgery market. After all, surgeons are private corporations (for profit inc), suppliers are private corporations (technology, infrastructure, pharma, supplies/materials, prosthetic devices and implants) and referring physicians are private corporations. Furthermore, insurance companies are also stakeholders, as they are expected to support employees and employers during the recovery and rehab phases of healing. Insurance Companies are very profitable corporations. The only publicly run component is the hospital. Yes, Yes…I feel you – the above private inc. examples are paid with public funds…indeed, they are – still, they are for profit corporations, the ones listed in your mutual funds, ex: GE, Merk Frosst, Telus, Philips, Medtronic, Power Corporation, Johnson & Johnson to name a few. Research, Faculties, Foundations and patients are beneficiaries.
So, lets have a debate about How to do healthcare well in Canada. For profit organizations are not the problem. They are not the ones causing long wait times and budget deficits. Poor management and politics in our public institutions are the cause of these.
Public funding of Healthcare is desired. Government oversight of facilities providing care is desired. As for the choice of providers, let’s give that to the consumers. The persons that benefits from the intervention.
What do you think?
Yes the for profit organisations are the problem. The best example is the one south of the border. When profit is the motivator the patient never receives the best care. It receives what is best for the investor who owns the health care center. The deaths in the long term care facilities in Ontario were overwhelmingly in for profit units. What is needed is the Feds to increase their share of money they transfer to provinces for medical care. It used be 50% now it is in the order of 15 or 16% if I am not wrong. So the main burden is on the provinces to come up with most of the money and obviously it is leading many of them to resort to private care options.
In the Canadian system it is profit that is the motivator for the healthcare offer too – even with the word public is in front of it.The system lets people die if there isn’t a profit to be made, or worse, the system allows physicians and technologies to assault patients beyond saving and without informed consent. A lack of ethics and greed are not issues exclusive to our neighbours south of the border.