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Ontario releases 3-step plan to invest in private care to reduce surgical backlog

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Ontario has released a new three-step plan that will see some for-profit community surgical and diagnostic centres take on more responsibilities, including additional surgeries and other medical procedures.

Speaking to reporters Monday morning, Health Minister Sylvia Jones said this will help reduce wait times and eliminate surgical backlogs.

“We need to be bold, innovative and creative,” she said, adding that all of these procedures will be covered for patients under the Ontario Health Insurance Plan (OHIP).

“We need to build on the spirit of collaboration on display across the health-care sector.”

The first step would be to invest in “new partnerships with community surgical and diagnostic centres” to reduce the waitlist for cataract surgeries, ensuring 14,000 more surgeries will be performed each year. These centres include both not-for-profit and for-profit clinics.

The government will also invest more than $18 million in existing centres to cover other procedural care such as MRI and CT scans, ophthalmic surgeries, minimally invasive gynecological surgeries and plastic surgeries.

The second step involves a further expansion of “non-urgent, low-risk and minimally invasive” procedures. Little detail has been provided regarding what additional procedures will be included.

The province will also be introducing legislation next month that will, if passed, allow these private clinics to conduct more MRI and CT scanning “so that people can access publicly funded diagnostic services faster and closer.”

As part of the third and final step of the province’s plan, private clinics will be allowed to conduct hip and knee replacement surgeries as early as 2024.

“We have great hospitals working hand in hand with the clinics and that's the way we're going to operate, excuse the pun,” Premier Doug Ford told reporters at Monday’s news conference. “That's the way we're going to move forward with this.”

CHANGES WILL BE PERMANENT

The legislative changes that will allow private clinics to perform more surgeries is not a temporary measure to deal with the backlog, Ford clarified.

“This would be permanent,” he said, citing an aging population and immigrant population who are in need of healthcare.

“This is one step of making sure we provide care. No matter if cataract, hip replacements, knee replacements, foot surgeries, diagnostics," he said while stressing this will take the burden off hospitals and allow them to focus on critical procedures.

Ontario Premier Doug Ford leaves an announcement on healthcare in the province in Toronto, Monday, Jan. 16, 2023. THE CANADIAN PRESS/Frank Gunn 

Health-care experts have warned about the possibilities of exacerbated staffing shortages in hospitals, arguing that investing in independent centres will squeeze resources from the public sector.

In a statement, College of Physicians and Surgeons of Ontario said they met with the Ministry of Health on Friday to reiterate their position that procedures such as hip and knee replacements should be connected to a hospital system.

Registrar and CEO Dr. Nancy Whitmore said that while she supports expanding access to diagnostic procedures in community settings, it has the potential of having a negative impact on staffing throughout the health-care system.

"We emphasized our ongoing concern about creating further strain on the present health care provider crisis particularly in skilled operating room nurses and anesthesiologists."

Ontario’s five major healthcare unions issued a call Monday for the Ford government to halt its plan, calling it “a risky venture that will cost Ontarians dearly and damage access to public care.”

It's a claim the province's opposition parties agree with. Incoming NDP Leader Marit Stiles claimed the plan will pull health-care workers out of hospitals, adding further strain to the system.

"The system as it exists right now is not working up to its full capacity. But that's because the government has failed to invest," she told reporters Monday.

"this plan isn't going to mean that people get services faster or better. It's going to mean that more and more people are left behind."

Ontario Liberal MPP Adil Shamji said there were too many unanswered questions and missing details in the Ford government's plans for him to be comfortable with the idea of for-profit care.

"If something sounds too good, it probably is," he said, adding that Ontario should ensure all community health clinics are not-for-profit.

“Doug Ford and Sylvia Jones refused to detail how they will fund these clinics or give assurances on how their plan will deliver actual value for our healthcare system."

When asked about staffing concerns, Jones touted the province’s previous commitments to hire more nurses and expedite licenses for international staff. She said that any new clinic will have to provide a human resources plan.

The Ontario Hospital Association has also come forward in support of the government’s investments in community clinics, saying it is an essential tool given the impact of COVID-19 on hospitals and human resources.

OVERSIGHT QUESTIONED

A 2021 auditor general report identified instances in which some surgeons conducting outpatient surgeries provided “significantly high or unreasonable billings.”

“Further, there has been no provincial oversight of surgery providers to protect patients from being misled about their right to receive the standard publicly-funded surgery without having to pay any fees out of pocket,” the report read.

“We also noted that providers of outpatient surgeries operate in silos, follow different reporting requirements, and are overseen by different parties.”

Jones was asked Monday about the concern of “upselling” services at for-profit clinics, which the auditor general previously said could result in patients being misinformed about what OHIP-covered services are available to them. She said that if a patient was not offered an OHIP model first, there is an avenue to bring it forward for a ministry investigation for a refund.

“Your family clinician is part of that process all the way through and they are truly the clinical experts to know what is appropriate and what is available in the province of Ontario,” she said.

The government has promised further legislation as part of the third step of their plan that will “strengthen oversight of community surgical settings so that patients can continue to expect to receive the world class care they know and deserve.”

No information was provided about what that oversight will include.

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