Layton and private health

This very topic just came up over here. It was the Shouldice Clinic, and it's covered by OHIP. It's 'private health care' in the same way that your doctor's office is.

Layton went to the Shouldice clinic in Thornhill for hernia surgery in the 1990s. As he says there, it was a veterans' clinic that was grandfathered into the system; hernias are what it specializes in; everyone knows someone who's had hernia surgery at the Shouldice. Peter Gzowski had surgery at the Shouldice and explained how it worked on radio. Sineed tells us that she's had surgery there. It's still public medicine; your doctor sends you there, and OHIP pays.

This is another of those undead rumours -- or maybe we should just call them lies -- about Jack and Olivia. Step on it hard.

Thanks guys. Knew I could count on you. I had a feeling it was something like that because I remember this coming up over and over.

Now back to facebook to throw the lie back in her face. Appritiate the legwork. Google sucks sometimes.

But there's still a HUGE problem with private clinics, although it sounds like the Shouldice Clinic isn't as bad as most of them. Comment?

The Shouldice is a private hospital but It is part of OHIP. Its world reknown and people go there for hernia surgery from all over the USA.

The right wingnuts will do anything to discredit Layton including telling lies.  

What about all the Xray and diagnostic private clinics? They all bill OHIP directly. My Doc has a Diagnostic clinic in his office. Never had a bill yet. 

Exactly.  We have a single PAYER health care system.  If OHIP pays for it, you're within the system.

I'm not sure I even understand the difference between public and private here. As far as i know, none of the hospitals in Ontario are directly managed by the Ministry of Health. They are all managed as non-profir corporations with their own boards of directors etc... so how is this any different from Shouldice which is also non-profit and is entirely paid for by OHIP. I just don't see how Shouldice is different from Sunnybrook?

Well, our hospitals are funny things. In some ways, they are private, or at least most of them are. The staff may be on the public payroll, but a lot of the facilities are more or less splendid because of private funding. For instance, I was so heartened the first time I walked into the lobby of Mount Sinai in Toronto -- and heartened means a lot when you're not well -- that they gained my loyalty just from that wonderfully cheerful space, but I'm sure it's as beautiful as it is because of private donations. St Mike's is a Catholic hospital, if public, and that can have some repercussions in certain areas of medicine *cough* reproductive. The Grace, which was just saved by the province (political manoeuvring during an election?), is run by the Salvation Army, although I doubt that has many repercussions -- it is a wonderful place.

Nursing homes are a whole separate story. Some are public (City of Toronto, eg), some public-private, some private.

I doubt that most of us know how to describe this system precisely, because it isn't actually organized along lines of strict principle in the first place. I suspect no one wants to look at that problem very closely because it would mean reorganizing so much and such huge sums of money.

I mean, in a perfect world, all hospitals and clinics would be owned by and run by government.  But what we have now are private practices all over the place, which offer services that are paid for by the government.  Is Shouldice a hospital or a clinic?  I don't know.  It's one of those grey areas, I guess.

We should fight to keep hospitals public.  Public-private partnerships are a huge problem - I don't want to see for-profit hospitals cropping up.  But Shouldice is one of those "exceptions" due to it being around forever and being grandfathered into the system.  It's too bad that it's privately owned, and I have no idea whether it is a for-profit operation or whether it's a non-profit these days.  It would be better if it were non-profit, but if the health care system has deemed it a publicly-funded clinic/hospital, then it's no different than getting your bloodwork done at Alpha Labs, or going to your doctor's private practice for OHIP-covered services.

Shouldice is really no different from a physcian in "private practice" - like my mother is - it's just on a bigger and more complex scale. My mother is a doctor who rents space in a privately-owned building. She's not employed directly by any public hospital. But if you go to her for treatment, you still "pay" for it through OHIP instead of out of pocket.

I think most abortion clinics operate the same way. I used to go to a "private" physiotherap clinic and still billed it to OHIP (back when physio was covered). Plenty of optometrists and determatologists operate private clinics as well, from my understanding.

Hmm...Stockholm, are you saying that the Shouldice is NOT privately-owned, and that it is a non-profit corporation?  Then what's all the hoopla about?  All hospitals are non-profit corporations, run by boards of directors, and are not owned by the government!

There must be something different about Shouldice because everyone always calls it private. Is it really non-profit? I think there's more there than just the hernia clinic.

I think it relates to them doing out of country service, which I assume means a bill is involved/

One of the arguments against private clinics is they suck doctors out of the public system... we had a thread on this recently. Here where I live, one of our doctors who travelled up and down the coast to the small villages has set up a private clinic in Blanc Sablon and no longer travels the coast, so he has to be replaced somehow, and it's a really tough job to entice doctors from elsewhere to work here.

Of course Shouldice is private - like most doctors and most practices in the country.

My understanding (such as it is) is that Shouldice Hospital is a not-for-profit entity, while its clinic is for-profit. Maybe someone who knows more can confirm this, or not.

In any event, nussy said above that all x-ray and diagnostic labs bill OHIP directly. Surely that can't be the case. Is it only Québec that is full of privately run outfits that bill the user (who may or may not have insurance coverage to cover the cost) for x-rays, MRIs, etc. - thus enabling them to jump the public queue?

I remember from previous threads that one of the hallmarks of private care is that the user pays either in part or in whole.

I also remember from many health care protests covered on the news chants and placards of "Health Card, not Credit Card" and similar such sentiments.

The Shouldice requires a credit card to secure an admission date.

http://www.shouldice.com/quest1.htm

The existence of that form does not prove that a credit card is regularly required.

LTJ is right - and anyway, semi-private rooms costs extra, no matter what kind of hospital you're in - if you want it (and I understand that all Shouldice rooms are semi-private), you either pay out of pocket or through your private insurance. And there may be other non-OHIP charges that they need a credit card on file for.

What about the private cataract clinics? They bill OHIP. There is also at least one private clinic where I was treated. http://digestivehealth.ca/index.html

What really pisses me off is a Basketball player can get an MRI done immediatly. Someone has to be booted to make room for him I would presume.

I have group Blue Cross extended health care coverage which covers prescription meds, and I think glasses and hearing aids. I also have group dental coverage through ManuLife. Both plans cover about 70% of costs, but cost me around $2000.00 combined annually. However, at one point my meds alone were costing more than $3,000.00 a year, now down to aout $2,000.00. I use my dental coverage not very often. The Quebec medicare plan covered the entire costs of my $2500 hearing aid, AND about $1,500.00 of assistive devices as I am hearing impaired (my Blue Cross group coverage only permits one hearing aid every seven years, I needed one after my four-year-old hearing aid proved insufficient). There's no way I could pay up front for a private clinic even if I were reimbursed later.

There was a good discussion of public/private health care on the Danny Williams thread.

aka Mycroft wrote in post#35:  Quebec also has the largest number of private surgical and diagnostic clinics in the country. As a result a large number of doctors have either left the fully public system or have reduced their availability and the result is longer waiting lists for those who can't afford to jump the queue. Same thing has happened in Australia. The larger the "private" or semi-public tier the longer the waiting lists for those who use the public system.

I will have waited almost two full years by the time I get my diagnostic procedure in Quebec. If the private system did not exist, and the public system was fully funded (as it should be!), would I have such a long wait?

What about laser eye surgery? I know that there are a number of private clinics in Canada - The Herzig Eye Institute, for one. I'm pretty sure those are entirely private - e.g. you either pay out of pocket or get it covered through private insurance. Anybody know?

Edited to add that I assume it's because laser eye surgery is not considered "medically necessary" - e.g. it's a personal preference, like getting breast implants or something.

Yes, that's why - though I suppose it would be possible in principle for the government to pay such a clinic to do medically-necessary procedures.

Laser eye surgery is considered to be like cosmetic plastic surgery. Its never covered by medicare and I've never even heard of any private insurance plan covering it - its something that if you want it - you pay out of your pocket - just like a face lift or a nose job.

BTW: I wish someone would change the title of this thread to "Layton and PUBLIC health" because the reality is that he has had all his medical treatments in the public system.

In Ontario, some eye care is considered medically necessary and some is not. The former is covered by OHIP -- it was my understanding that all cataract care, eg, is covered -- I say that because mine is. (I haven't had surgery yet, but I can go in indefinitely for exams, until my doc thinks the cataracts have "matured." Heh. I have adolescent cataracts.)  Eye care is one of those things that varies from province to province, like physio, and often changes within a province -- Ontario has become stingier.

Yeah, I think that, basically, provinces can determine on tehir own what is and isn't "medically necessary". I know in Ontario, things like routine optometry, physiotherapy and chriropracty were once covered and now are not. The de-listing of physio particularly pisses me off because I know very well that in many cases it certainly IS "medically necessary."

Eye examinations are "on the province", every two years.

Major dental surgery is paid by OHIP if you are in a long-term-care institution.

Long-term-care institutions (nursing homes) were public (with some private for the uber wealthy) before Mike Harris.  He ensured that the existing requirement for more than 3 hours care per resident was lowered, bathing became a once-a-week procedure, and the Trillium Foundation was called on to help build privately-run institutions like Extendicare.  That all made for-profit LTC profitable in ONtario. McGuinty brought in twice-a-week bathing (showers) and upped the budget for food, and is now re-building some of the dank, smelly, four-to-a-room pens that passed for nursing homes in previous epochs.

However he can't build enough of them fast enough to ease pressure on intensive-care beds in hospitals where old folks are stacked up.  All a result of three decades of calls for lower taxes, of course.  One can only hope that the most demanding of the lower-tax crowd wind up in the oldest of the LTC facilities themselves. In a room with someone who plays "hurtin' music" from dawn to dusk. 

"The Shouldice requires a credit card to secure an admission date. http://www.shouldice.com/quest1.htm"

A family member used the Shouldice clinic for an operation. We did not have to have or use a credit card. I did have to cover the first night's room fee which was $50.00. They billed her for the bed the other nights but the operation itself was covered by OHIP.

In Canada we have public insurance but private delivery. Public insurance only covers a limited amount of what is deemed to be necessary procedures. Provinces have the ability to delist certain procedures from provincial health plans. Hospitals also charge for extra services and I believe some still charge for private rooms.

This is the main confusion in Canada over health care. Private insurance vs public insurance. The issue is not about private delivery.

I've had surgery at Shouldice, as has my father and my uncle.  It doesn't require credit cards.  The surgery is paid for by OHIP but they bill you for a semi-private room; if you have extended medical benefits, it's covered completely.  

Eye exams have been delisted by OHIP for adults, but they're still covered for kids under 18.  

SHOULDICE HOSPITAL LTD.
An Anomaly in Health Care Delivery
Background
Shouldice Hospital is a private hospital established in 1945 by Dr. Edward Shouldice in Toronto
and licensed by the Ministry of Health. In 1953 the facility moved to Thornhill, Ontario just north of
Toronto. The Shouldice family still owns the hospital. The hospital performs hernia operations
exclusively.
Shouldice Hospital is an anomaly because it was, in essence, “grandparented” as a private
hospital by Ontario’s Private Hospitals Act in 1973 as Ontario moved to public medicine. Article 3
(1) of the Act specifies that hospitals whose licenses were issued before October 29, 1973 only
would continue to stay in existence. New for-profit hospitals cannot be licensed under this
legislation. Furthermore, any transfer of license or transfer of share capital of a corporation holding
the license of a grandparented facility, requires prior approval of the Minister of Health.
The hospital employs 12 full time surgeons who operate solely within the private hospital and are
licensed by the College of Physicians and Surgeons of Ontario. It has 89 semi-private beds.
Surgical costs and the cost of the hospital ward for hernia operations for Ontario patients at the
Shouldice are covered by the Ontario Health Insurance Plan (OHIP).
A second private hospital, The Institute for Traumatic and Reconstructive Surgery, was also
“grandparented” at the same time but has since ceased operation.
Is the Shouldice Hospital the same as a private surgical facility
under Bill 11?
No. The Shouldice exists because it was in existence pre-medicare and entrenched in the Private
Hospitals Act. It performs only operations for hernias. Granted, the Shouldice has developed a
procedure that makes it very efficient but it should be noted that the Shouldice does not accept
more complicated hernia surgeries that may require anything other than the routine procedure.
This is typical of for-profit health care. It is a form of cream skimming – accept the routine cases
and leave the more complicated and expensive ones for the public sector.
There is no reason why such specialized expertise cannot be developed in the public sector with a
free-standing facility that is publicly funded and within which the services are publicly delivered.
                                                                                Continued .....
At the present time, the Shouldice Hospital does not charge any additional user fees or any
charges for enhanced services other than for private rooms. They make their money by providing
specialized treatment that is paid for by OHIP and by providing services to out-of-province and
out-of-country patients.
Surgical fees for international patients are $US 2,400 (approximately $3,600 Cdn) for all hernia
types including all surgical, laboratory and hospital charges. U.S. patients covered by Medicare
(for seniors and the disabled) are partially covered by that plan.
Conclusion
The Shouldice Hospital is not an example of private health care as an alternative to public health.
It does not pose the same threat under NAFTA that Bill 11 in Alberta poses. Neither does it pose
the same threat to public medicare that Bill 11 poses. There is no ability under the Private
Hospitals Act for any additional private hospitals to be licensed in Ontario.
Shouldice Hospital is nothing more than an anomaly, a throwback, “grandparented” as a pre-
condition to public medicare.
March 2000
CUPE Research

http://www.healthcoalition.ca/shouldice2.pd

 I think the Shouldice hospital is considered a "Centre of Excellence" in their field, which seems to be the way of hospitals in Ontario these days. 'General Hospitals' are fewer & farther bewteen these days.