12/11/12

Should we tolerate secrecy for public health care?

It's amusing to review the course of events that led to the revelation of the secrecy concerning the problems at private surgical and diagnostic clinics.  
Queen's Park. Photo: Paul Bica

The doctors lobbied to move surgical and diagnostics work from the hospitals.  The government let the emerging industry slip free of public reporting and oversight.  

Subsequently, after a death (and a coroners report), the government required the industry to face some modest oversight in 2010 -- not by a public authority, but through self-regulation by the docs . (Remember, the doctors had lobbied to expand the industry in the first place.)

Then in the fall of 2011, following disclosure that 6,800 patients would have to be notified that faulty infection control procedures at a private clinic could have exposed them to HIV or hepatitis, Health Minister Deb Matthews declined to introduce oversight by a public authority, despite public pressure.  Instead she comments,  "Government can't do everything.  A professional (regulating body) like the College of Physicians and Surgeons, they take responsibility for their members....At this point I am delighted the College is taking that responsibility seriously and has found a problem that we need to fix."  

Eventually the College of Physicians and Surgeons releases a report on the private clinics that mentions that some 29% of the private clinics fall short in some way -- but the College won't tell us which ones -- or how they fell short.  This is "taking the responsibility seriously" it seems.

Notably, the College is so distant from public control and so oblivious to public opinion, that the report is heartily self-congratulating.  They were, it seems, expecting accolades.

Now the minister promises she will improve the public accounting by the physicians and surgeons, although exactly how remains unclear. Will we ever find out the clinics that fell short, but did not outright fail?  Or how they fell short?  Will we receive annual public reports?

The underlying problem is that public disclosure runs contrary to the interests of private providers -- not just in the clinic business, but everywhere privatization appears in health care.  It reveals secrets to competitors and problems to the public.  Both threaten the ability of investors to remain in business, making profits.

It may be fine to tolerate secrecy regarding the production of widgets, but it is not appropriate to keep secrets about the production of health care services. We need our providers to cooperate and share their knowledge, not keep it to themselves.  This is even more important when those providers are funded by the public buck.

2 comments:

  1. Deb Matthews on CBC Radio yesterday: "I am a huge believer in transparency". That's hard to swallow, given the support she gave to the OHA's successful attempt to water down the FIPPA, via what opponents (including the Ontario Health Coalition, OPSEU, OCHU and SEIU) termed the "Hospital Secrecy Act" slipped into the Ontario government's budget bill of May, 2011. Of course it's vital that private sector healthcare providers be open to regular public scrutiny. But the same is true of the public sector. In this province, a small coterie of powerful hospital CEOs sets the agenda -- and it's high time for some real transparency in Ontario's hospital sector.

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  2. Quite true, Fiona. The thing is the public naturally expects that public institutions will make information public, and is irate when they fall short (as in the case you point out). But I think you'd have to be pretty naive to expect that of the corporate world.

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