Too big to fail.
For most that expression applies to big banks, but what about our health care?
As Ontario prepares the way for further transfer (read: privatization) of hospital services to mostly for-profit independent health facilities, it’s a good question to ask.
When the government recently decided earlier this year to end its relationship with 90 private OHIP designated physiotherapy clinics , it was revealed that these clinics were almost all owned by just four companies.
The same narrowing of interests also occurred in Ontario’s home care, where the former competitive bidding system ushered out many of the smaller players.
That’s far from healthy.
We’ve previously said that if you want to see the future of Ontario’s health care system, look to England.
In England they have similarly contracted out community care to a handful of very large health corporations. UK Author Colin Leys, who teaches in universities on both sides of “the pond,” says these companies are too big to control, making it difficult to enforce public contracts.
For example, on nights and weekends after-hours primary care is supposed to be provided in Cornwall by SERCO, a UK-based private for-profit company. Yet at times the 535,000 residents of this 1,316 square mile region have had to get by with just a single doctor during those hours.
When confronted by the allegation, a SERCO spokesperson told the media that this had only occurred during a “limited” number of occasions, and usually there are two doctors available.
Well don’t we all feel that much better now?
If you are going to contract out health care, you better get really specific. Leys, speaking by video link at the Ontario Health Coalition Action Assembly and Conference this weekend, said one English Public-Private Partnership hospital couldn’t understand why the contractor had not put seats on any of the hospital’s toilets. The response? The seats were not specified in the contract, only the toilets.
With the Cameron UK government deciding it was no longer going to pay for treatments of “limited clinical value,” and facing a rising threshold for public coverage on procedures such as hips and knees and cataracts, more of the English are responding by taking out private health insurance – something conservatives are pushing for in this country.
Leys warns that the more private insurance the English buy, the more the future of the National Health System is thrown into doubt.
“As soon as the middle class loses interest, the NHS is done,” he said.
What’s stopping that from happening right now is that the middle class are increasingly unable to afford private medical insurance.
Leys is careful to distinguish between England and the rest of the UK, which appears to have learned its lesson about market-based health care.
As Ontario looks to strip more services out of its hospitals, it should consider what is happening in England. Those hospitals too have seen their more lucrative services stripped clean by the private sector.
Leys says a crisis is building. Hospital emergency rooms are overwhelmed, and nearly half of the public hospitals in England are now considered financially unviable. Primary care practices are also being overrun.
Administrative costs are rising with the increased complexity of the relationship between the public and private sphere. Leys says during the 1970s about 5 per cent of NHS costs were administrative. Now it is somewhere between 15-20 per cent.
The Ontario Minister of Health should think long and hard about the future of hospitals. With a freeze on hospital base budgets to 2018 and an irrational funding formula that is leaving some hospitals facing negative funding challenges, the hundreds of independent health facilities now barking for a piece of the action may yet push our system over the edge.
One colleague said it sounded like a pack of wolves attacking a buffalo. They enrage the animal with a series of bites until it is driven into the water where the wolves can then climb on top of the beast and finish it off.
Nice future, huh?