Ontario’s healthcare system is notably struggling.

We need to expand access to primary and community care, strengthen our healthcare workforce, and deliver integration to increase care quality and reduce costs. We also need to defend equity and our public healthcare system.

At the same time as it underfunds a healthcare system in crisis, the Ford government calls the expansion of for-profit surgery clinics a “bold” answer. (https://www.cbc.ca/…/fao-report-project-deficit-lower…)

It strikes me as a lazy one at best, with no concern for equity or efficiency.

We should be careful not to overstate the case. Our system of public health insurance largely protects the core idea that everyone deserves the same quality of care. And there is already a fair amount of for-profit delivery that is covered by that public health insurance. Equally, we should take seriously the credible concerns about upselling in for-profit clinics.

Per the Auditor General: “the Ministry has no oversight mechanism to prevent patients from being misinformed and being charged inappropriately for publicly funded surgeries…patients often complained about being charged after receiving a publicly funded cataract surgery because they were misinformed of their right to receive standard surgery, free of charge through OHIP, without any add-ons.” (https://www.auditor.on.ca/…/en21/AR_Outpatient_en21.pdf)

And what of efficiency? Dr. Bell calls the move “a big mistake,” pointing out that it’s likely to exacerbate an already acute labour force challenge in the public system, and that it has failed to reduce wait times in Alberta and Saskatchewan where it has already been tried. “Many hospitals, including in Ontario, have already established high-efficiency community surgery centres and most would be eager to expand community surgery facilities with incremental funding from the government.” – Dr. Bob Bell (https://www.theglobeandmail.com/…/article-ontario-does…/)

One need not be ideological to demand some evidence that for-profit delivery will reduce wait times and improve patient care. And one should rightly be skeptical after Ontario’s disastrous experience with for-profit seniors’ care in the course of the pandemic. While the OMA didn’t initially take a strong view as between for-profit and non-profit, it subsequently “clarified its position that Integrated Ambulatory Centres should provide OHIP-funded services as not-for-profit clinics.”

Meanwhile, the CPSO advised that “this wasn’t the solution to the healthcare crisis and would further tax our health human resources shortage and further increase wait time for more urgent hospital-based care.” The CPSO also rightly called for integration with hospitals.

If one cares about efficiency – higher quality care at a lower cost – health integration should be a central focus of all governments. “This factor – lack of integration – emerged time and again as the single most important barrier to innovation.” (https://www.canada.ca/…/report-advisory-panel…)

Here’s Tommy Douglas: “The 1st phase would be to remove the financial barrier between those giving the service and receiving it. The 2nd phase would be to reorganize and revamp the delivery system, and, of course, that’s the big item. It’s the big thing we haven’t done yet.” Public health insurance is non-negotiable. When it comes to reorganizing and revamping the delivery system, we should care about what works. We should care to follow the evidence. The Ford administration seems entirely uninterested in these questions.

To close, and as Dr. Naylor wrote 20 years ago, Canadians should “re-embrace the core concept of a universal health care system in which the vast majority of services are provided by non-profit institutions with public accountability.” (https://www.cmaj.ca/content/cmaj/166/11/1416.full.pdf)