Private clinics are not the solution to health-care cuts

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One in seven private health-care clinics in Ontario have failed provincial safety inspections. Since 2011, Hepatitis C outbreaks at three colonoscopy clinics have caused at least 11 patients to become critically ill. And the second and third outbreaks could have been prevented if the first one had not been kept secret. People concerned with the state of health care in Ontario are left with many questions: how did we get into this situation? Who's to blame? And finally, how do we stop the off-loading of hospital services onto privately run clinics?

The first question goes back to the 1990s. Massive cuts to federal transfer payments were immediately followed by Premier Mike Harris' cuts to the health-care system. As a teenage activist I recall meetings in community centres and church basements about how to stop what was referred to at the time as "ambulance tours" of Ontario -- where paramedics were turned away from over-flowing emergency departments and patients were dying before space could be found for them at another hospital.

But since then, the funding situation in Ontario remains dire. According to Natalie Mehra, Executive Director of the Ontario Health Coalition (OHC), funding to "Ontario's hospitals [has] already been cut for 20 years. We have suffered the deepest cuts in Canada. We actually have the fewest hospital beds left per person of virtually every country in the OECD."

Which brings us to the current controversy about private health-care clinics in Ontario. Successive Liberal governments in Ontario have offered private clinics as the solution to under-resourced hospitals. Assurances are made that they will be non-profit and regulated, implying that they will function like a typical family doctor's office. But virtually every hospital service that is now provided in private clinics is subject to user fees and co-payments. Which means that patients are being asked to pay twice: once through taxes that fund our health-care system and then again, out of pocket. And unlike income tax that is collected according to means, flat fees at clinics unfairly disadvantage people with low incomes.

Some clinics offer services that you are unlikely to find in a hospital, such as hair implants and elective cosmetic surgery, but other clinics are providing services that belong in hospitals, such as colonoscopies and pain management. They have business models that are entirely inconsistent with public health care. Despite some being technically "non-profit," clinic owners and managers can accrue large salaries when they cut corners and charge the province for excessive "overhead costs." This leads to the question of regulation. Despite officially existing under provincial regulation, private clinics do not have public boards like hospitals. This set-up means that a grey area exists where public accountability is limited to regulation by the College of Physicians and Surgeons (CPSO). The CPSO has been historically secretive about outbreaks in private clinics and Ontario residents have no access to these clinics' decision-making structures.

Recently, there has been increased scrutiny of private clinics, largely thanks to OHC campaigns and investigations by the Toronto Star. This past spring, the OHC held a public referendum. Tens of thousands of ballots against the offloading of hospital services onto private clinics were collected and then delivered to the Ontario legislature in July.

At the same time, the Toronto Star was investigating the Hepatitis C outbreak and the province's failure to publicly expose clinics that failed safety testing. Health Minister Eric Hoskins was pressured into action, promising to provide greater oversight and make information about clinic regulation and testing publicly available. But as the OHC points out, such promises have been made and broken for years. And even if regulatory measures commensurate to those existing for hospitals were implemented, private clinics cannot replace hospitals if we are to have a public and accessible health-care system.

I have written extensively about my personal experiences with the Canadian health-care system. As a person living with Crohn's disease, I have had dozens of bowel scopes in the last 12 years. Thankfully all of them have been in hospitals. I cannot even imagine if the complications of my disease were paired with battling Hepatitis C contracted in a health-care facility. But even if safety standards were followed and my health experience was positive, I also cannot imagine having to worry about paying for such essential diagnostic testing when I was already too sick to work.

In Ontario there are currently over 800 clinics providing more and more of the services that hospitals also provide. The actions we require -- across all provinces and territories -- are for governments to adequately fund public hospitals and work with us to make them even more democratic. Continuing the erosion of hospital services and then offering substandard privately owned clinics as the solution is an affront to the public health-care system we have built and continued to fight for over the last seven decades.

Join the Ontario and Toronto Health Coalitions at Queen's Park this Friday at noon to say no to private clinics and to demand funding for our public hospitals.

Next month's column will be on debunking myths about public health care, just in time for holiday dinnertime discussions.

Julie Devaney is a health, patient and disability activist based in Toronto. Her rabble column, "Health Breakdown," is an accessible, jargon-free take on the politics behind current health-care stories. You can find her on Twitter: @juliedevaney

Photo: Jennifer Morrow/flickr

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