Skip to main content

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
Director

Comments

Popular posts from this blog

Ford government fails to respond to 72% increase in COVID inpatient days, deepening the capacity crisis

COVID infections continue to drive up hospital costs and inpatient hospitalizations in Ontario. For the most recent fiscal year (April 1, 2022- March 31, 2023) hospital stays related to COVID cost $1.221 billion, according to new CIHI data.   This is about 4% of total hospital spending, creating a very significant new cost pressure beyond the usual pressures of population growth, aging, inflation, and rising utilization.   Costs for COVID related hospitalizations increased 22.2% in Ontario in 2022/23 from the previous fiscal year, rising from $999 million to $1.221 billion.  That rise is particularly notable as the OMICRON spike of late 2021 and early 2022 had passed by the the 2022/23 fiscal year.   The $222 million increase in COVID hospitalization costs came in the same year as the Ford government cut special COVID funding and, in fact, cut total hospital funding by $156 million.     In total, there were 60,653 COVID hospitalizations...

The hospital crisis: No capacity, no plan, no end

While Canada has achieved universal public healthcare coverage, that does not mean conservative forces have given up trying to erode that coverage and expand corporate care where it does not currently exist. The battle has become particularly intense in Ontario under the Ford Progressive Conservative government, which is implementing serious cuts to the level of care and moving to bring in for-profit mini-hospitals. Inadequate Staffing.   Less and less of hospital spending is on staff.   Employee compensation as a share of hospital expenditures has consistently shrunk in Ontario. This is not some immutable law of hospital development.  It is in stark contrast with the rest of Canada, where compensation has become a larger share and now accounts for 67.1%. Hospitals in provinces other than Ontario now have 18 percent more staff per capita than hospitals in Ontario. Overall, if Ontario had the same staffing capacity as the other provinces and territories, there would be another...

The long series of failures of private clinics in Ontario

For many years, OCHU/CUPE has been concerned the Ontario government would transfer public hospital surgeries, procedures and diagnostic tests to private clinics. CUPE began campaigning in earnest against this possibility in the spring of 2007 with a tour of the province by former British Health Secretary, Frank Dobson, who talked about the disastrous British experience with private surgical clinics. The door opened years ago with the introduction of fee-for-service hospital funding (sometimes called Quality Based Funding). Then in the fall of 2013 the government announced regulatory changes to facilitate this privatization. The government announced Request for Proposals for the summer of 2014 to expand the role of "Independent Health Facilities" (IHFs).  With mass campaigns to stop the private clinic expansion by the Ontario Health Coalition the process slowed.   But it seems the provincial Liberal government continues to push the idea.  Following a recent second...