Dr. Doris Grinspun

The dangerous seduction of investor-driven care

Since I last wrote to you, dear members, a lot has changed in the health-care landscape. In January, the Ontario government announced a plan that will undermine our public health system – directing public funds and surgeries to for-profit clinics in our province. 

We as nurses know that for-profit “solutions” lead to lower quality of care – the evidence is overwhelming. But do members of the public – your patients and clients – understand the implications? 

The government’s rhetoric is seductive. The premier and health minister say this move will bring care closer to home, shorten waiting times for procedures and reduce the surgical backlog caused by the COVID-19 pandemic. Who wouldn’t want to wait less to reduce their pain, restore their mobility or improve their vision? Our premier is lauding this plan as “innovative.” What could be bad about innovation? 

Well, that depends on what the word “innovation” is used to describe. True innovation – such as creating specialized surgical centres within public hospitals to do a substantial number of standardized surgeries, including cataract procedures and knee and hip replacements – is welcome. It would optimize the use of existing infrastructure by deploying operating rooms (OR) and recovery rooms for non-emergency procedures 24-7. It would realize efficiencies, while maintaining the standards and capacities of a high-quality public hospital, resulting in a stronger public health-care system. 

The problem arises when “innovation” is used as a code word for “profiteering” – which will be the end result of the government’s plan. The for-profit motive – and the accompanying competition and added administration – means a substantial portion of each health-care dollar will be diverted away from direct care delivery.
Premier Ford says this plan will not lead to a two-tier health system. But at the same time, he and the government have opened the gates to profit-seekers. Nurses focus on the evidence. Look south of the border and you know what happens when you place investors and corporations at the helm of the health system. The legal obligation of investor-driven corporations is to make profits for its investors. Patients are, by law, secondary. 

For-profit clinics aggressively “upsell” their services. As reported already in Canadian media, patients in Ontario are often urged to pay additional fees to get a “better” procedure over and above the one covered by OHIP. Or, for example, patients might even be persuaded into premature joint surgeries, rather than first trying non-surgical interventions to see whether those alleviate their pain. As I recently noted when asked to share my perspective on the proposed move to for-profit surgeries on Healthy Debate, getting more doesn’t necessarily mean getting better. 

The profit incentive can also lead to cutting corners by hiring fewer staff or hiring people with limited skillsets. Moreover, for-profit providers typically don’t have the infrastructure to provide care for patients who become unstable. If a patient in their care experiences a serious adverse event or crisis, that patient will be sent swiftly to a public hospital. 

Investor-driven “independent health facilities” (IHF) skim the system of the profitable patients and leave public hospitals with higher acuity and insufficient resources. The impact is decreased safety and quality in both our public hospitals and the IHFs. 

What the Ontario public needs to know: this move will strip precious dollars from a health system already struggling with the impact of the COVID-19 pandemic. Wait times will worsen, not improve; patients will get less than they’ve already paid for in their taxes. And, those who access IHFs also lose out because of potential upsells and corner-cutting to extract profits.

It’s a losing proposition all around.

RNAO has repeatedly cautioned the Ontario government about the dangerous path they have chosen, largely because it will worsen access, decrease quality and increase cost. In addition, it will have serious implications for the longstanding crisis in nursing and other health human resources. As nurses, we’re fully aware of the exodus of our colleagues, maybe even yourself, from the hospital system due to inadequate compensation and impossible workloads. Many have also left home care and other community settings. Investor-owned clinics will exacerbate this problem, and the greener – at least, dollar-wise – pastures they might offer contain many pitfalls. 

Hospital CEOs have shared with me quietly their huge concern that the opening of investor-driven clinics will aggravate the shortage of nurses in hospitals. They are right, and they should be saying it out loud. And, as we all know, when nursing is in crisis, the health system crumbles.

We must uncover for our colleagues, friends and the public what lies ahead on this slippery slope to a two-tier “American-style” health system. Consider the experience of our friends and relatives in the U.S., where millions struggle to access services without insurance. Others are forced to stay in jobs they don’t like for the health coverage, and even then face cancelled treatments or “medical bankruptcies” due to insurance limitations. And, the minority that can afford the “extra billings” are exposed to more procedures and surgeries than likely needed. 
This is a path we must avoid at all costs. I fear that the government’s coded language of “innovation,” “efficiency” and “prudent fiscal stewardship” may get in the way of people’s understanding of the full implications of the move to investor-driven for-profit IHFs.  

Thankfully, the Supreme Court of Canada gave Canadians oxygen when on April 6 it decided not to hear a B.C. doctor's appeal on a challenge over access to private health care which had been dismissed by the province’s court of appeals. In doing this, Canada’s highest court sent a strong message of approval for the principles of universal access to health care. Let’s build on this judicial decision to stop any further moves towards investor-driven IHFs in Ontario and elsewhere in Canada.  

There is a better way to fix what’s wrong in our health-care system. This starts with opening our public hospitals’ ORs and recovery rooms 24-7 to clear up surgical backlogs, using existing infrastructure. RNAO has laid out this and other plans to strengthen a publicly-funded and not-for-profit delivered health system, including retaining and recruiting the nurses needed to keep Ontarians healthy. Let’s tell our politicians that’s what we want and let’s do so loudly. We will not stand for a privatized system driven by profit-seeking investors.

Winter 2023
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