OPINION
This was the subject of a presentation by Andrew Longhurst at the Mount Community Centre one evening in June. Longhurst is a health policy researcher, political economist, and PhD candidate in the Department of Geography at Simon Fraser University in British Columbia. The event was sponsored by the Peterborough Health Coalition.
In November 2023, Longhurst released a report focused on Ontario’s health care system: At What Cost? Ontario Hospital Privatization and the Threat to Public Health Care, prepared for the Canadian Centre for Policy Alternatives. In his presentation, Longhurst outlined changes in health care service delivery that have been introduced in British Columbia, Alberta and Ontario.
In May, 2023, Ontario passed legislation allowing more health care services to be provided in for profit hospitals. Longhurst argues that expanding private delivery of services destabilizes public hospitals and puts increases staff shortages in the public sector. It also introduces a risk of extra billing for health care services, which is contrary to Ontario legislation and the Canada Health Act.
In Longhurst’s view, for-profit health care delivery is more expensive than public sector delivery, and introduces financial conflict of interest in medical decision making, which can lead to upselling, self-referrals, and clinically unnecessary procedures, with the potential of risking patient safety and quality of care.
His report outlined a number of “evidence-based policy strategies” to improve service delivery within public hospitals, something the researcher documents in the report as superior to further privatization.
The June 18th meeting provided clarity on different forms of privatization and how the line is be being blurred. For example, Bill 60 replaces the Independent Health Facilities Act (IHFA), which has regulated “independent health facilities” since 1990. The new Integrated Community Health Services Centres Act (ICHSCA) provides a new legislative framework that expands the types of procedures performed in independent health facilities (now called “integrated community health services centres”) and entrenches these facilities as part of the publicly funded health care delivery system, alongside public hospitals. These are for profit facilities. The Auditor General of Ontario noted that 98 percent of independent Health facilities fall into that category.
The report noted expressions of interest by the American Pharmaceutical industry’s trade association, Pharmaceutical Research and Manufacturers of America (PhRMA), which in 2003 earmarked $1 million earmarked to lobby change the Canadian healthcare system. Longhurst points to a 2008 report indicating that in the mid-1950’s, Canadian and American health indicators (such as life expectancy and infant mortality) were very similar. But by the end of the twentieth century, the severe health inequalities present in the United States were absent in Canada, where the very poorest 20 per cent of Canadians enjoyed the same life expectancy as average Americans. This indicates that the Canadian healthcare system works for citizens regardless of their income. That is an accomplishment that deserves acknowledgement.
Countries whose governments participate in the delivery of health care are struggling with increased costs as demographics change and better but more costly treatments are introduced. Canada is no different. In Canada responsibility for health care shared by two levels of government, and in some cases downloaded to municipal governments. This allows blame for failures to be passed on, according to Longhurst. If he is correct, and privatization actually increases health care costs, legislation promoting this policy shift such as Bill 60 should be retracted and better solutions developed. Independent review of the report by members of the Financial Accountability Office of Ontario and the Parliamentary Budget Officer could provide insight from both the provincial and federal authorities.
For more information or to review this report, visit www.policyalternatives.ca and search for Andrew Longhurst and the topic of for-profit health care. Concerns about health care policy should be directed to local MP’s and MPP’s as well as opposition leaders.
By John Fallis