Defend Public Healthcare

The Ontario government has gotten into another donnybrook with private clinics for a second time in less than a year.   Over the summer, they got into a messy dispute with private physiotherapy clinics. The government stopped 94 physiotherapy clinics from directly billing OHIP. Ontario Health Minister Deb Matthews said that, over the years, licences to provide these services have been bought up by large corporations.   Moreover, she charged, the " existing 94 clinics have had an unlimited ability to bill the government   and have become very creative in they way they bill." The government claimed that an audit of 15,000 records from the clinics found that 58% of them failed to support OHIP billings.  Five-minute exercise classes were sometimes billed as physiotherapy,  care plans did not measure up, record keeping was incomplete, and  physician referrals were sometimes lacking. “There is extraordinary growth in expenditures and the audit was one of those factors

Ontario has the highest share of private health care expenditure in the country, according to data in a recent report from the Canadian Institute for Health Information (CIHI).   Private expenditures in Ontario run to 32.3% of total health expenditures, higher than any other province (Saskatchewan is at only 24% private expenditures, Manitoba at 25.3%, and Alberta 27.1%).   Total public sector expenditure in Ontario in 2013 is forecasted at only 67.7% of total health care expenditure, significantly below the Canada-wide average of  70.1%.    While the Ontario public sector expenditure is down a tick from last year (67.8%) , the Canada-wide public sector average is up 4/10ths of a percent (from 69.7% to 70.1%).    This year, public sector expenditures in Ontario would need to increase 6.3% just to meet the Canadian average -- a $248 increase per person.  So it is perhaps not so surprising that private health expenditures are 5.3% higher in Ontario than Canada as a whole ($1

Lurking only slightly below the surface in the recent fight over changes to funding for physiotherapy is yet another problem with health care privatization. The government is stopping the ability of 94 physiotherapy clinics to directly bill OHIP. Ontario Health Minister Deb Matthews says that, over the years, licences to provide these services have been bought up by large corporations. Currently, two-thirds of the billing goes to four companies that are, she says, "behind the protests" against her reforms. Moreover, she charges that the " existing 94 clinics have had an unlimited ability to bill the government and have become very creative in they way they bill." By reforming how the money is distributed, the government claimed they will provide physiotherapy, exercising and fall-prevention classes to 218,000 more people, mostly seniors .   And they are going to do this while providing less money for physiotherapy than they otherwise would:  $16,000,0

In May, as the chemotherapy drug mixture scandal swirled, the Ontario Hospital Association tried to  distance  the contracting out of chemo mixtures from the cost cutting that is so widespread in hospitals at the moment:  "Contrary to the assertions of some commentators and unions, the outsourcing of compounding by hospitals was not driven primarily, or even secondarily, by cost considerations in most cases."   Hmm... OCHU's release on this issue did not suggest the contracting out was done to cut costs -- there was no evidence on this point at the time.  Instead, among many other points, OCHU noted examples of contracting out costing more . The OHA claims hospitals were motivated by the health and safety of their employees (god bless 'em), patient safety, best practices, etc, etc., etc.   But not money.   Despite the OHA claims, however, hospitals are mixing their own drugs, without reports of duff chemo mixtures -- unlike the contracti

A commission of inquiry has heard that SNC-Lavalin deliberately went around Quebec's political party financing rules, leading to a flurry of donations to the governing Quebec Liberal Party in 2009. The donations came as the engineering firm was bidding on a major hospital construction project, the media reports. What is not reported, however, is that this is a privatized P3 project. One of the biggest in fact. These privatized P3 projects are designed so private sector corporations get their mitts on a much larger share of the booty than they would under normal procurement (e.g. billions of dollars in financing for the projects). Former SNC-Lavalin vice-president, Mr. Yves Cadotte said SNC-Lavalin knowingly reimbursed its senior staff for their political donations. (Corporations are not allowed to make donations, or to reimburse their executives for their donations to political parties in Quebec.) SNC-Lavalin employees gave $101,200 to the Quebec Liberals in 2009

The majority of the costs reported by the Auditor General for the cancellation of the Mississauga gas plant were payments to the U.S. based investment firm that provided financing for the project -- $149.6 million. The private company doing the project (Greenfield)  negotiated  expensive financing for the project with this U.S. investment firm -- 14% annual interest. Compared to the cost of public financing, that is through the roof, perhaps 7 or 8 times higher. The Auditor General confirms this interest rate, and adds that "Penalties for Greenfield’s defaulting on the agreement were heavy: Greenfield would have to immediately pay back all amounts drawn with interest, as well as interest on the full undrawn amount for the full eight-year term of the agree­ment." Worse, "the OPA (the Ontario Power Authority, which was acting for the government after it decided to cancel the project) was unaware of any of these onerous penalty terms when it signed a Novembe

Martin Regg Cohn, Queen's Park columnist for the Toronto Star ,  expressed his outrage at some length today at the College of Pharmacists.  Apparently, they did not answer media questions  about the diluted chemotherapy drug scandal quickly enough. But he says nothing of the response from the private corporation that actually mixed the chemotherapy drugs That company has -- according to the Star's sister paper, the Spectator -- repeatedly refused interview requests and refers questions to the Ministry of Health and LTC.  Early on, it  reportedly threatened legal action  if its name was mentioned and  suggested  the problem lay elsewhere.  As one CEO at an affected hospital said yesterday “They have not been forthcoming, for whatever reason, with a lot of information.” This illustrates a key difference between public bodies and private corporations -- the former are expected by the public and the media to be open, the latter, not at all.  So when you privatize

Contracting out of medical transcription work is becoming more common in Ontario hospitals. So it is noteworthy that our sister union in BC, the Hospital Employees Union,  reports  today that "the cost of outsourcing medical transcription services in the Lower Mainland has increased by an average of 26 per cent a year over the last five years, according to financial documents produced by health authorities." Regardless, the health authorities "plan to completely contract out in-house medical transcription later this year and fire about 130 medical transcriptionists (MTs), who currently work directly for health authorities." Currently, about 50 per cent of medical transcription volume is contracted out in B.C. HEU has also raised questions about the accuracy and privacy of patients’ medical reports when transcribed by a network of home-based workers across the country.  The Union has asked B.C.’s privacy commissioner to investigate. Photo: Wistechcolleges

Health Edition reports that the Quebec Health Minister has decided not to renew the contract with  RocklandMD, the private hospital that has done about 9,000 publicly funded surgeries since 2008 in Quebec. The contract expires September 2014.  While the private clinics have tried to edge into the business via simpler surgeries, RocklandMD   claims   to be able to perform  a broad range of day surgeries, “from the simplest to the most complex, in various specialities and within very short times.” The public health insurer found  that RocklandMD was charging people illegal facility fees (a charge often leveled against private clinics).  RocklandMD disputes this and is resisting attempts to recover the money.   Health Edition reports that the matter is headed  for   (where else?) the courts.   Quebec plans to bring all the surgeries back into the public system.  Meanwhile, Ontario is looking to turn surgeries over to private mini-hospitals.    Photo:SCFP

ORNGE providing a vital service.   Photo: Jason Edward Scott Bain The Globe and Mail kindly lobbed a few questions for the disgraced, former boss of ORNGE, Chris Mazza to swat away.  His responses, published in this weekend's edition , suggest the government was fully onside with his vision -- until the fur hit the fan. He said he could not grasp why he suddenly became a pariah. “Until November, 2011, I was being incentivized, told I was doing grand things. Not just by my board and by investors, but by deputy and assistant deputy ministers. They cheered me on, constantly. My premier cheered me on.” As evidence, he proffered a handwritten letter from Premier Dalton McGuinty written in March of 2009, congratulating him on, as Mr. McGuinty wrote, “the success at Ornge. You are doing a lot of good for a lot of people. Proud of ya!” “So in November, 2011, I’m great,” Dr. Mazza concluded, “and in December, pardon me, I’m a piece of shit. What changed?” Mazza may have been a

Photo:  LOLren As with hospital beds, the government and other proponents of  the near freeze in new long-term care beds suggest that home care can take up the slack. Does this stand up?  Well, let's take even a very aggressive version of this theory.  Say that 25% of all people in LTC could be dealt with through home care.   (Currently, that would mean evicting 19,250 LTC residents, which is hardly realistic!) As noted in the previous post , the demographics of the province are rapidly changing, with huge growth in the elderly population, now and into the years ahead. A 2011 study the Conference Board concludes "based on Statistics Canada‘s reported utilization rate by age and the Government of Ontario‘s population projection, it is estimated that by 2035—when boomers are 71 to 89 years old— 238,000 Ontarians will be in need of long-term care."  That is 161,000 more than the 77,000 LTC beds existing now.   If we somehow can subtract 25% from 238,000 we still

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,   " Gover

Queen's Park in Darkness (Grant MacDonald) Yesterday I fumed about the gall of one academic who claimed that privatized P3s (public private partnerships) had actually increased  public transparency. Even more evidence came today that privatization leads to a lack of transparency.  Not only is the Ontario government turning more surgeries and procedures over to private clinics, they have contracted out the oversight of these outfits to the College of Physicians and Surgeons. Today, the  Toronto Star  reports that the College of Physicians claims that legislation passed by the Liberals putting the College in charge of inspections of these clinics, also prevents the College from actually telling the public which clinics are providing sub-standard care!  "We are not allowed to discuss the failed premises" says the College president, Dr. Bob Byrick.  As a result, we do not even know where the clinics are located. It remains unclear if even the Ministry of Health &

Red Squaring by Rob Caballero The corruption scandal rocking a public private partnership (P3) hospital project in Quebec has raised some significant doubts about P3s in Canada. Over the weekend even the normally pro-privatization Financial Post ran a story considering such doubts. They allowed that the size and scope of P3 projects may make the projects a magnet for greed. The Financial Post was, however, able to dredge up an academic to claim that P3s had improved public transparency. This is pretty galling.  In fact OCHU/CUPE, several other unions, and the Ontario Health Coalition (OHC) had to go to extraordinary lengths to get any significant information about P3s. Even with the assistance of a very expensive legal challenge we were only able to get information for very restricted purposes, and only after much to do. "Commercial confidentiality" requires privatization to proceed under a cloak of secrecy.  The corporations don't want to let anyone know

Health care privatization continues to come to Ontario via the Liberal government's version of "community care."  Most obviously this comes by moving services from public hospitals to poorly regulated and for-profit retirement  homes.   That has been a repeated theme in the Liberal government's version of community care. Alex E. Proimos Another mainstay is moving services to for-profit "home care" providers.  Except, now for-profit home care is often for-profit clinical care.     Typically, the Liberal line is we need to move services and clinics out of public hospitals and into the home.   But now the government organizations that oversee home care (Community Care Access Centres  or CCACs) are beginning to celebrate moving services out of the home and back into clinics.  But this time the clinics are run by for-profit corporations, not public hospitals.   In a recent news story sparked by the opening of a new clinic, the Erie-St. Cla

MUHC The Washington Post reports that the sales "of Canadian project-finance bonds are lower this year as an ongoing investigation of alleged corruption in the Quebec construction industry makes the debt more expensive to issue." The American paper adds that the "inquiry into corruption in the Quebec construction industry, which led to the resignation of Montreal Mayor Gerald Tremblay on Nov. 5, is souring sentiment among investors in private-public partnership bonds linked to projects for hospitals and universities in Canada’s second-largest province." The McGill University Health Centre (MUHC) P3 project is now under police investigation. The National Post reports that questions are being raised whether " illicit cash payments helped the SNC-Lavalin consortium win the MUHC contract." Three weeks ago the police raided the downtown headquarters of the MUHC. The National   Post notes one unconfirmed report alleged that there was a secret $2

Health Sciences North hospital in Sudbury is planning to replace 30 hospital beds with a 25 bed unit inside a private retirement home, the  CBC  reports. OCHU/CUPE members protest earlier bed closures at Health Sciences North Richard Joly of the Northeast Community Care Access Centre says  "We are committed to reducing the population that are currently residing in hospital." Like many other hospitals, Health Sciences North is grappling with a significant deficit as government funding is squeezed.   Six million dollars in the case of HSN. Hospital officials claim the hospital beds cost $750 per day each and putting 25 beds in a private retirement home would cost $4 million less than having them at the Memorial hospital site.  In February, the hospital will stop funding the 30 beds. Similar strategies have been tried in other locales with disastrous results. In Windsor , a local hospital paid hundreds of thousands of dollars to remodel a for-profit retirement hom