Ontario’s provincial government announced in early 2023 that it was looking to shore up an overburdened public healthcare industry by incentivizing private clinics and allowing them to perform certain elective surgeries (DeClerq, 2023). This is a large step in shifting the “layered” financing of public healthcare in Ontario to including covering the costs of private healthcare for specific surgeries and diagnostics.
For most Ontarians, moving some operations and surgeries to private clinics will not impact how they receive healthcare. Its impact is uniquely felt from an operational and governmental standpoint on the provincial level. Ontarians will still get the care they want and need but must rely on properly implementing private clinics through the provincial government. On the other hand, Ontarians should keep an eye on the levells of increased spending that is likely to occur from financing for-profit clinics.
Since the government intends to allow “for-profit,” as in these clinics can charge rates they believe are fair, CUPE (a large union for healthcare workers) suggests that it may increase the desire for underpaid healthcare staff to move out of the public system into private healthcare and create even more vacancies at public hospitals (CUPE, 2023). More critically, the provincial government intends to use OHIP (Ontario Health Insurance Plan) to cover the costs of these private clinics (Crawley, 2023). The outcome is that the private clinics may potentially up-charge the province on services provided.
To confuse matters, the surgeries and diagnostics that private clinics will be allowed to perform, are also performed by public hospitals. First, I will explain a little bit about how Canadian healthcare functions: Martin et al. (2018) suggest that Canadian healthcare can be separated into three distinct layers :
- Public services such as hospitals, physicians and family doctors, public clinics, diagnostic services
- A mix of private and public such as institutional long-term care homes, prescription drug coverage, and home care
- Private coverage such as physiotherapy, vision care, and dental care.
For most Canadians, it can be a bit concerning hearing talks about “privatization” and different funding models for their healthcare. Rest assured that these private facilities are not eliminating government funding or the specified surgeries from the public but are simply an option to help publicly funded hospitals (Crawley, 2023). On the other hand, Ontario’s plan to move for a more open system regarding surgery and diagnostics blurs the lines between each layer of public health. COPE Ontario, a union representing a section of the healthcare workers in Ontario, argues that this shift will inarguably change how Canada’s funding split (70% tax to 30% private) interacts with Ontario healthcare (Farisco). The provincial government has yet to release how much it will allow private clinics to up charge OHIP for the services provided.
To the average on-looker, allowing new private clinics to perform surgeries the public system would otherwise perform seems counter-intuitive to what to the Canada Health Act; disrupting the balance will indeed cause at least some type of reaction down the chain of funding, whether it be reduced funding for public services due to the offloading of specific procedures to private facilities, or simply a drain of healthcare talent to the private sector and the United States (Marfo, 2022).
On the other hand, this begs the question, what about other countries that rely on the relationship between public and private funding for healthcare? All OECD countries rely on the private sector for some healthcare services. One end of the spectrum is the United Kingdom (UK), where the NHS is a publicly funded healthcare provider that differs from Canada in a few significant ways, most notably by including publicly provided services for all “layers” of the healthcare system. Notably, The UK allows private practices, but these services are available publicly to all residents. On the other end of the spectrum, the United States has limited publicly funding for Medicaid, medicare programs, and other programs ( compared to other OECD countries) but relies heavily on private insurance and privately owned primary healthcare providers and hospitals to provide healthcare (Schoen et al., 2010). By allowing private clinics to perform the same surgeries and diagnostics as public hospitals, the Ontario government is placing Canada squarely in the middle between private and public. It is also placing it odds with the federal government which is seeking to create a more comprehensive system through dental and pharmacare programs.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7957357/#R30
In summary, the Ontario Progressive Conservatives are attempting to shore up the overburdened hospital waiting lists by allowing for-profit private clinics to do specific procedures and diagnostics. Although these privately owned clinics, Ontarians will not directly foot the bill out of their own pocket — however, Ontarians will still foot the bill more extensively through taxes. Instead, OHIP will pay for services secured at private clinics like publicly funded clinics or hospitals. The impact is twofold:
- Canada does not have a fully comprehensive, publicly funded healthcare system. Some things fall out of the scope of the public system, such as dental care, pharmacare, home care, long term living. The newly proposed private-public partnership does not impact or improve upon these systems. Instead, it shores up already available publicly funded services that may suffer from long wait times and understaffing.
- The private clinics are for profit. This means that they can charge the provincial government any rate they see fit. In the future, should these clinics remain an essential part of Ontario healthcare, the public could be on the hook for excessive fees.
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References
About the NHS. (n.d.). Step Into The NHS. https://www.stepintothenhs.nhs.uk/about-the-nhs
Crawley, M. (2023, January 13). Ontario poised to give private for-profit clinics bigger role in surgeries | CBC News. CBC. https://www.cbc.ca/news/canada/toronto/ontario-doug-ford-private-clinics-health-care-1.6712444
DeClerq, K. (2023, February 21). Ontario tables health-care bill to expand role of private clinics. Toronto. https://toronto.ctvnews.ca/ontario-tables-health-care-bill-to-expand-role-of-private-clinics-1.6282893
Farisco, P. (n.d.). Privatization of Healthcare in Ontario—Part 1. COPE Ontario. Retrieved 15 April 2023, from https://www.copeontario.ca/privatization_of_healthcare_in_ontario_part_1
Ford’s plan to expand private clinics in Ontario will cost patients dearly, risk lives and significantly worsen staffing shortages, health care unions say. (2023, January 16). Canadian Union of Public Employees. https://cupe.ca/fords-plan-expand-private-clinics-ontario-will-cost-patients-dearly-risk-lives-and-significantly
Marfo, D. (2022, October 26). Nurses leaving Canada doubled in the last five years amid health-care crisis. Toronto. https://toronto.ctvnews.ca/nurses-leaving-canada-doubled-in-the-last-five-years-amid-health-care-crisis-1.6126807
Martin, Miller, A. P., Quesnel-Vallée, A., Caron, N. R., Vissandjée, B., & Marchildon, G. P. (2018). Canada’s universal health-care system: achieving its potential. The Lancet (British Edition), 391(10131), 1718–1735. https://doi.org/10.1016/S0140-6736(18)30181-8