The Washington PostDemocracy Dies in Darkness

Opinion The wrong way to fix Ontario’s health-care crisis

Ontario Premier Doug Ford. (Nathan Denette/AP)
5 min

There’s no question that Ontario’s public health-care system is strained — to the point of catastrophe.

In November, the average stay in the emergency room for admitted patients in the province was 22.4 hours. The Ontario government says the waiting list for surgical procedures tops 200,000. Last fall, patients in one city were left outside in the ambulance bay for hours waiting to be let into the hospital. Nurses are burned out and quitting or considering quitting in droves.

These failures are cruel — and can be deadly. But Ontario Premier Doug Ford’s plan to ease the stress by expanding for-profit medical services is the wrong way to fix the problem.

Ford’s plan, unveiled on Jan. 16, will move tens of thousands of cataract surgeries, hip and knee replacements, MRIs, CT scans, colonoscopies, and endoscopies out of hospitals and into for-profit and not-for-profit community facilities. Many critics decry it as a step toward the privatization of public care.

It’s not quite that. The plan, whose model exists in one form or another in British Columbia, Alberta, Saskatchewan and Quebec, doesn’t require patients to pay for primary care out-of-pocket — medically necessary services will still be publicly funded — and doesn’t allow wealthy patients to skip the line. David Jacobs, president of the Ontario Association of Radiologists, asserts that the plan is “Health Canada compliant” and “not a for-profit, American-style health care expansion in any way, shape or form.”

Nevertheless, it will potentially allow half a billion dollars yearly to flow to private, for-profit facilities. As such, it is a financialization of the medical system, opening it to becoming primarily a financial instrument for investors rather than a public good. Institutional investors who enter the sector will aim to maximize their profits. That most likely means either trying to sell more services to patients or running a leaner, no-frills operation. Or both.

The data suggest for-profit care is expensive in more ways than one. A report from the Canadian Centre for Policy Alternatives suggests the for-profit shift in British Columbia since 2015 hasn’t solved the province’s health-care woes but has led to unlawful extra-billing and a drain on the public purse. In the United Kingdom, for-profit medical outsourcing has led to an increase in deaths, according to a study published in the Lancet. Ontario has its own analogous data regarding long-term care facilities. The province’s for-profit homes, which account for about 58 percent of the total, had more covid-19 deaths per home than not-for-profit homes.

A significant concern is the policy changes will cannibalize the public system by luring away doctors, nurses and technicians with the prospect of more money or better hours. Ford has hand-waved about protecting hospitals by requiring community clinics to provide their staffing plans, but there’s no guarantee that will help. Ford also plans to make it easier for health-care workers from outside the province to practice in Ontario, but that just moves the crisis around. Bringing in practitioners from abroad and training new ones, meanwhile, will take time.

There are better ways to deal with this crisis. Moving certain procedures out of hospitals is a good idea, says former Ontario deputy health minister Robert Bell, but they should go to not-for-profit facilities. Danyaal Raza, a family physician and assistant professor at the University of Toronto, agrees. Innovation, he says, would be “taking successes from hospital-associated community surgical centers and making that the standard.” In Ontario, these surgery clinics are efficient, specialized and private not-for-profit hospital extensions that perform procedures outside the hospital — outside the pressures of the profit motive. And they have a track record of getting patients looked after sooner rather than later.

The government should also drop its appeal to restore Bill 124, which caps pay increases for public sector workers, including nurses, at 1 percent. It was struck down by the courts in November. “Bill 124 has got to go,” says Birgit Umaigba, a clinical nurse specialist who speaks and writes about nursing from the front lines. The bill, she says, is driving nurses into private facilities — or out of the profession. Umaigba also advocates for speeding up the years-long process to get internationally educated nurses into the system.

Further, the province could improve its referral systems. Melanie Bechard, a pediatric emergency physician and chair of Canadian Doctors for Medicare, says a system of family doctors referring patients to a centralized pool of specialists “has been proven to significantly reduce wait times across Canada and the world.” Expanding multidisciplinary medical teams can also help, she notes, by providing patients with treatment from different specialists — physiotherapists, mental health professionals, dietitians and others — as they process through the system, sometimes avoiding the need for procedures or surgeries altogether. None of this requires reinventing the wheel. “We have the right tools for success,” Bechard says. “But we need to expand these models.”

Ontario’s health-care system needs reform. It does not need more financialization. Instead, the province ought to reinvest in public and not-for-profit care while expanding best practices. In that space, unlike with doctors and nurses, there is no shortage of ideas that work.