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What's best for health care: competition or collaboration?

The head of the Ontario association of for-profit home care corporations, claims, "As a direct result of competition today's home care system is more accountable, has better client service indicators and has greater transparency than it did in the past."

Which is news to many of us. Not least because there has not been any real competition in Ontario home care since the Ontario government was forced to suspend the compulsory competitive bidding process years ago, due to complaints from the community.

In fact it is now almost seven years since the process was first suspended.

So... competition delivers results -- even when there is no competition?

It is, however, interesting that the Home Care Association is publicly advocating for the old system: it sounds a bit like they hope to get competitive bidding back once the election is out of the way. If so, the failure of the PCs won't help them, especially if the Liberals fail to get their majority, as it seems now (11:42 pm  October 6).

A true alternative would be a health care system based on cooperation, collaboration, and integration, rather than competition. It has proven much more efficient than competition in the health care insurance industry. Below is the letter from Natalie Mehra, Director of the Ontario Health Coalition on this.

Re. Competitive Bidding Hurting Home Care, Letter October 3 & response October 6, by Sue VanderBent, Executive Director, Ontario Home Care Association, Hamilton
To the Editor,
We heartily support the call for an end to competitive bidding and a full review of Ontario’s home care system.
Home care competitive bidding -- the system of contracting out home care services -- has spawned massive protests and is so unpopular that it has been placed on moratorium not once, but twice. If the newly elected provincial government continues to extend the current moratorium, it will simply entrench for-profit privatization of vital health care services.
With a very few exceptions, the only proponents of competitive bidding are the companies that want to use the bidding system to win greater market share or increase their profits. Their interests are often contrary to the public interest.
Competition for contracts among provider companies is a potent force that blocks information sharing and service coordination. In fact, competitive bidding necessitates extra tiers of administration and fragments rather than integrates service.
Studies show that the for-profit companies in Ontario’s home care system have a higher mark-up than the non-profits in order to make room for profit-taking from their taxpayer-funded contracts. The for-profits overtly support two-tier home care. They want more user fees for patients on top of government funding as these give them more revenue streams from which to take profits. They have lobbied against extending basic employment standards to some of the most marginalized workers in Ontario’s health care system.
In contrast, the public interest is in enhanced stability and continuity of care, better coordination, and vastly improved equity of access to home care. Public values align with non-profit service delivery and its ethos of caring before profit-taking. Tight budgets necessitate efficient administrative structures that prioritize funding of front-line services. All of these would be better served through the creation of a stable public/non-profit home care system in Ontario.
As more services are cut and moved out of hospitals, all of us who support public health care and its principles of equity and fairness should be concerned about the privatization of home- and long-term care and the negative influence of the growing for-profit home care companies on Ontario’s health care system.
Natalie Mehra


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