Auditor’s Report — Warning flags about diagnostic self referrals

Today’s release by the Ontario Health Coalition regarding the 2012 report by the Auditor General of Ontario: 

Toronto – The Ontario Auditor General’s report released today raises warning flags about inadequate access to care and the perils of for-profit privatization.

The Auditor General found wait times for long-term care that are extraordinary. Crisis clients are waiting more than three months for placement and wait times have tripled. The provincial Ministry of Health response did not mention the lack of long-term care beds, only its plans to download patients into home and community care where funding per client is lower than it was a decade ago.

In Ontario’s privatized clinics (Independent Health Facilities) the Auditor found inadequate monitoring, poor inspections, a lack of financial oversight and inequitable access to care. This is of significant concern as the government is moving more and more services out of hospitals into privatized clinics.

 Among the Auditor General’s key findings:

  • Waits for mammography are up to ten and a half months in some areas of Ontario (page 47) but mammography screening, particularly in smaller hospitals has been closed down and centralized out-of-town.
  • Almost one-third of patients who require follow-up colonoscopies are not receiving them within prescribed wait times, and wait times remain too long.
  • Wait times for long-term care placements have tripled since 2004, with median wait times at 98 days in 2011/12 (page 186). In March 2012 people in crisis waiting for long-term care placements had waited a median of 94 days up to that point; moderate-needs clients had waited 10–14 months; and most other eligible clients had been on the wait list “for years”. Further, during the 2011/12 fiscal year, 15% of clients died before receiving LTC home accommodation (page 187).

  • Access to long-term care home placement is inequitable, based on geography and wealth. The auditor found that applicants living in some areas of the prov­ince get into LTC homes more quickly: in one region 90% of clients were placed within 317 days, whereas in another region it took about 1,100 days until 90% of clients were placed. Further, while LTC homes can designate up to 60% of their beds as preferred accommodation (that is, private or semi-private with higher bed fees) only 40% of applicants apply for these more costly beds. Therefore, regardless of care needs, clients who can afford to pay for preferred accommo­dation get placed more quickly than other clients.
  • Note: The adequacy of levels of care in long-term care homes and for those people redirected to home and community care were not studied by the Auditor General.
  • Ontario’s private clinics (Independent Health Facilities) provide inequitable access to care. 50% of communities are under-serviced for radiology, ultrasound and pulmonary function tests. Fee for service means that services tend to locate in larger areas leaving other areas underserved. This also tends to increase income for those with larger clinics or in corporate chains because of decreased overhead costs even though the province makes similar payments per procedure (page 151).
  • There is no monitoring of referral patterns within and among corporate conglomerates where doctors in one clinic refer to another service also owned by the same doctor or the same company and no monitoring of the need for these services, even though there is an obvious financial conflict of interest (page 151).
  • The clinics were inadequately monitored and inspected for safety and costs. This includes clinics with radiation-emitting technologies. The Ministry did not even know where they all were (page 152).
  • Note: Two corporations control 23% of all Independent Health Facilities (IHFs are mainly for-profit clinics).

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