Privatizing Ontario's health care could result in worse outcomes: expert

Documents leaked earlier this week by Ontario’s NDP appear to show that Doug Ford’s government is working to privatize aspects of the province’s health care system.

NDP Leader Andrea Horwath claims the files reveal that services like inspections, laboratories, licencing, devices, and Ornge (a non-profit air ambulance and associated ground transportation service) are expected to be privatized. Health Minister Christine Elliott was quick to shoot down the claims, saying the documents were preliminary drafts and there’s no measure in place to privatize such services. She did admit that there were aspects of the plan that her government is considering.

Toronto-based family doctor Danyaal Raza is an assistant professor at the University of Toronto and board chair for Canadian Doctors for Medicare. He spoke to Yahoo Canada about what Canadians should know when it comes to the privatization health care.

Financing vs. delivery

Raza says there’s some confusion around privatization and health care since there’s two things people talk about when they use that word: private financing of healthcare services, versus public financing of healthcare services.

There is also the issue of delivery.

“When you deliver healthcare services, the actual delivery organization can be a not-for-profit organization or a for-profit organization. They’re not the same thing,” he says. “You can have public financing of a health care service that can be delivered on a for-profit or not-for-profit basis. You can have private financing that can fund the same sort of thing.”

Medicare refers to the public financing of hospitals and many health services. Once the government collects tax revenue, the provinces and federal government use it to jointly fund hospital and physician services. Although hospitals are funded by tax dollars, they are private institutions — but private not-for-profit institutions.

For-profit vs. not-for-profit

Not all health facilities work like this. Ontario’s nursing home sector, for example, has some public funding, but can run on a for-profit or not-for-profit basis.

Raza says research points to meaningful differences between the two models. Studies have looked at the costs associated with for-profit versus not-for-profit delivery in nursing homes, dialysis centres, and hospitals, analyzing outcomes such as mortality, and morbidity.

“When you look at the studies that have sought to answer this question, the not-for-profit organizations perform better on both costs and health outcomes than the for-profit institutions,” he says. “Not-for-profits tend to have lower cost per patients and for-profit ones have higher mortality and higher morbidity.”

Levels of transparency

There’s less research into why that is, though there are theories. One is that there’s less transparency for the patient or consumer in the health care sector.

Raza uses the example of buying a cell phone and cell phone plan: a consumer can see how much it’s going to cost and the features they’re going to get and compare one plan to another. With health care facilities like dialysis centres or a nursing home, it’s more challenging to compare since things are less transparent. You can judge things that don’t make a difference in health outcomes, like if it has a nice waiting room or if the magazine subscriptions are up to date, but you can’t observe if the instruments are being sterilized appropriately, or if the doctors are overworked.

“It’s harder to judge the quality of care you’re getting,” says Raza.

He adds the theory is that there’s increased incentive in for-profit institutions to lower revenues and cut corner for things that might affect patient care, which don’t necessarily correlate to customer satisfaction.

The wealthiest are the healthiest

Raza explains that the patients who are most profitable tend to be the healthiest and the wealthiest. This can be problematic when health care is turned into a profit-generating activity, since the goal is to reduce expenses and maximize revenue. That way, there’s an incentive to only tend to the people who are easiest to treat and who facilities can generate the most revenue from.

“It’s a perverse incentive when you introduce the profit motive,” he says. “You’re not going to necessarily treat the people who are the sickest and often the people who have the most difficulty accessing care.”

More regarding the future of Ontario’s health care system will surely be uncovered in the coming months. Raza says examining its current state is an important thing to consider.

“There’s this other conversation we’re having now about whether or not we want to expand for-profit delivery and use public funding to do that,” he says. “There’s cause for us to pause and think carefully about it. In my opinion, I don’t think expanding for-profit delivery for publicly funded services is a good thing.”