Francesca Grosso says she is an established expert in health care policy. A former PC health care policy director, her day job these days is a principal at Grosso McCarthy, a public affairs company for hire.
So when she writes in the opinion pages of the Toronto Star, as she did on Sunday (What’s Behind The Attack On Clinics?), who is she really shilling for? Who paid for this?
The piece itself is full of misinformation about private delivery of health care, a situation that might be embarrassing to her professionally given her claims to expertise.
She argues that private clinics are getting a bad rap as a result of a Toronto Star series that reveals nine private clinics failed a quality inspection by the College of Physicians and Surgeons.
She says, “we don’t know how hospitals would have done” if they had undergone similar inspections. In fact we do. Hospitals have to undergo a regular accreditation process every three years. You’d think someone who spent time in government would know this.
She says there is no link between quality and the type of ownership. There are plenty of examples. Here’s just one: This spring’s Ontario Task Force on long term care reports the municipal, non-profit and charitable homes provide 0.8, 0.4 and 0.14 additional hours of care per day than their for-profit counterparts. That’s significantly more support for residents in non-profit homes.
She says she has worked for “hospitals, not-for-profit and private clinics. All charge for OHIP, not patients for insured services.” The suggestion is they all get paid the same.
This is not exactly true. Private clinics have an incentive to do as much as possible, medically necessary or not, given they can bill directly to OHIP. What is not covered by OHIP, they are not shy about directly charging the patient.
Hospitals are covered under the Canada Health Act and are not allowed to charge for medically necessary procedures. They get some funding by procedure, but most services are covered under a global funding model (one the province is presently eroding).
In the lab world this is a significant difference. By law hospitals are not allowed to conduct lab tests collected in the community. This work has been given to the private sector at a considerable premium. Hospitals do not charge by the lab test. Private labs do. The difference in cost, according to a consultants report in 2008, is about 50 per cent more in the private sector. Not only that, but it takes longer to send lab tests great distances to central private labs than to have them done in the immediate community hospital. Does Grosso not see this also as a quality issue?
It is really galling to see Grosso raise the issue of MRIs. Last year we found out through the Local Health Integration Networks that Ontario hospitals were being allocated $260/hour for MRIs. Hospitals do an average of 1.5 MRIs per hour. By comparison, Canada Diagnostics, a private for-profit MRI company that operates clinics in BC, Alberta and Quebec, states on its website that it charges between $900 and $1600 for an MRI. MRIExam, another private company that claims to do work across Canada, including for Ontarians, says it charges between $750 to $950 for an MRI.
Grosso says the results are the same, private or not, but clearly there is a very significant difference in cost and who gets access.
When you book through MRIExam they want 20 per cent down at the time of your appointment. If you cancel, you forfeit that deposit. At an Ontario hospital? Are you kidding?
Recent polls have shown Ontarians to be wary of privatization, particularly in health care. They have good reason to be.
Grosso talks about vested interests. Ours our transparent – we represent the professionals and support staff who work in the public health system every day. Hers? Not so much.
So, who should you really trust?
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Sauce for the Goose, Sauce for the Gander
I read the letter to the editor by Richard Janson, Campaigns Officer at OPSEU, critical of my Op Ed piece on the need for specialty clinics in Ontario (essentially reinforcing my point about vested interests).
Here are some of the “facts” that the union has advanced to support its anti-specialty clinic campaign with my comments:
Mr. Janson writes that because all procedures in specialty clinics are covered by OHIP fees, there is potentially an incentive for physicians to do unnecessary procedures.
Reality: OHIP fees are provided to doctors throughout our system, in and out of hospitals for insured procedures. There is no added incentive for a doctor to perform unnecessary insured services in a specialty clinic.
Mr. Janson also disagrees with me that we don’t know how hospitals would have performed had they been subjected to the same inspection as the specialty clinics. He feels we do know because, hospitals “have to undergo” a similar process called an accreditation every three years.
Reality: Hospital accreditation remains a voluntary process–a good housekeeping ‘seal of approval’, in which virtually all hospitals participate. However, unlike in other jurisdictions, the Canadian hospital accreditation body, Accreditations Canada, is not a regulator with the authority of law to revoke a license or impose penalties for bad results. The test is different. The decision to release individual results is up to the hospital.
Specialty clinics are subjected to mandatory inspections by the College of Physicians and Surgeons of Ontario, a regulatory body with full legal authority to impose penalty or revoke licenses.
Scrutiny, transparency and consequences need to apply to both hospitals and specialty clinics in equal measure. In the spirit of Christmas I maintain, ‘sauce for the goose, sauce for the gander’.
Its inaccurate to say we have an anti-speciality clinic stand. What we are against is private for-profit entities operating within the public system with little accountability and no transparency. Can you even have accountability without transparency?
Hospitals have to deal with more than just accreditation, and we don’t know of any public hospital in Ontario that doesn’t go through the accreditation process. Hospitals also have to post performance data and sign accountability agreements with the LHINs. The Minister has the ultimate power to appoint a supervisor and take over the board of a public hospital. When errors occured in the surgery of Hotel Dieu Windsor, the hospital was taken over by the Ministry. This year hospitals also became subject to freedom of information, albeit in a more limited fashion than we would like.
There could be more transparency and accountability — we agree that the results of accreditation should be made public. We also believe that hospitals should be subject to review by the Ontario ombudsman.
On the other hand, we don’t even know which nine clinics failed inspection, nor the outcome of what the College of Physicians and Surgeons of Ontario has even done in response. To suggest that somehow this is superior accountability to what hospitals undergo is absurd.
Meanwhile, how health care is funded does matter, or are we choosing to ignore the move away from fee-for-service in primary care or the new funding formula being phased in for hospitals? Clearly the government has recognized how health care is funded has a direct impact on delivery. The example of labs is a very clear one and the impact is measureable, as is the impact of for-profit privatization of publicly delivered health services.
When you reveal your own client list, then we can have a discussion about vested interests. It is, after all, the season of giving.