Bravo to more private clinics in Ontario


Many of the arguments put forward against more private provision of health services have no factual base and are promoted by those who personally gain from the current system. Pictured: Premier Doug Ford. Photo Credit: Doug Ford/X. 

This week the Ford government announced that they would be seeking applications from private providers to expand the number of clinics doing MRIs and CT scans to increase the number of these scans that can be done in Ontario. Currently, there are only seven clinics of this type in the province. The current plan is to add enough clinics to do a further 100,000 scans annually. The government claims this added capacity will bring down wait times for these scans significantly – from current wait times of 81 days for CT scans and 90 days for MRIs to 28 days for both scans right across the province. The government intends these procedures to be fully covered by OHIP.  

Adding private health care resources is always a hot political issue. Predictably, the Ontario NDP and Liberal parties were immediately critical following the announcement, accusing the Conservatives of furthering their overall privatization agenda and warning that private clinics will try to “upsell” patients on services that will not be covered by OHIP. NDP leader Marit Stiles used the example of a cataract surgery in a private clinic, where the patient could be convinced to purchase an upgraded lens. Interestingly, this type of “upselling” is already widespread in public hospitals, where cataract patients are offered a higher quality lens for added cost which is not covered by OHIP. Opponents to private provision of health either are not aware of or ignore the fact that the public hospitals they so favour are already involved in quite a bit of “upselling” outside of OHIP. 

Although opposition politicians and self-interested groups such as the unions were in high dudgeon about these changes, there was little reaction from the general public. The horrendous state of our health care system has lowered the resistance of most citizens to experimenting with different solutions, as the current approach is clearly not working. Canadians have been hearing the dire warnings of leftists, unions and others that we cannot accept any deviation from our public system for decades and aren’t buying it anymore.  

Another fiction is that our current system is largely “public.”  About 40 per cent of health care services in Ontario is already in private hands – while still covered by OHIP. Many diagnostic services, long term care facilities and at home care, among others, are already private and largely work very well – at least as well as the public system and often better. 

The Ontario government has made no bones about its plans to expand the number of private facilities that offer various procedures such as cataract surgeries, knee and hip replacements and others. Anyone who has taken the trouble to read some international comparative studies of different health care systems in various countries know that the best-performing systems in the world incorporate private and public provision within a single payer structure – in other words universal coverage. 

Experience in other jurisdictions – including in some other Canadian provinces – shows that while patients might initially have some reservations about private health care services, they rapidly become supporters once they experience it. As is proven in any marketplace, more competition raises the efficiency and service quality of all players, or they don’t survive. Ontarians are all too familiar with being treated poorly in the public system due to excess demand and no incentive to do better as there is no competition. Once someone experiences a private clinic they are impressed by the higher calibre of service and end up favouring a private clinic over a public hospital. Perhaps this is exactly what concerns the proponents of a public health care monopoly. 

More private sector providers will also require a more informed health care consumer. Too many Ontarians are used to going to a doctor, taking their recommendation for a specialist or treatment, and never questioning anything. This should not happen even in a predominantly public system, where some medical professionals and treatment options are better than others. With even more choices in a hybrid public/private system, an informed health care consumer should be able to more readily find an option that suits them with a little research and shopping around. 

Many of the arguments put forward against more private provision of health care services have no factual base and are promoted by those who personally gain from the current system. There is no doubt that our current system has major flaws, especially considering that we pay one of the highest per capital costs in the world for health care services that are mediocre at best. That being said, it makes sense for some elements of the system to remain public, such as most hospitals undertaking serious surgeries and emergency departments. 

However, for routine procedures such as cataract surgeries, joint replacements and hernia surgeries, among others, the notion of having specialized private clinics that only provide certain procedures and are therefore likely to be efficient and very good at it, makes a lot of sense. These procedures are also ones that have some of the longest wait times. Experience in other universal health care systems around the world shows that a private/public system provides better health outcomes at less cost. The fact the general public is not resisting a different approach is encouraging. It may be that the only legitimate criticism of the Ford government’s approach is that they are not moving fast enough.

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