Ontario Premier Doug Ford is defending his new bill to expand the role of private health clinics, while the federal government says it is reviewing the draft legislation to ensure it complies with the Canada Health Act – the law meant to guarantee access to health care regardless of ability to pay.
A spokesperson for federal Health Minister Jean-Yves Duclos said Wednesday that his office is looking at Ontario’s draft legislation closely. The province’s bill, unveiled Tuesday, is designed to allow the expansion of private, for-profit surgical centres that will do more publicly funded outpatient procedures such as cataract eye surgeries, and starting next year, hip and knee replacements.
“We are aware of the government of Ontario legislation introduced yesterday and will be reviewing it closely to ensure it respects the Canada Health Act,” spokesperson Emelyana Titarenko said in an e-mailed statement Wednesday.
“Our government will continue to work with provinces and territories to ensure that our investments are used in a way that respects the Canada Health Act. We will always protect Canadians’ equitable access to universal health care services, and will never hesitate to take action to uphold the act.”
Caitlin Clark, a spokesperson for the Premier, said Tuesday that, if passed, the legislation will put into law that people “will always [have] access to insured services at community surgical and diagnostic centres with their OHIP [Ontario Health Insurance Plan] card and never their credit card, consistent with the Canada Health Act.”
Prime Minister Justin Trudeau, who recently concluded a multibillion-dollar health care funding deal with the provinces and territories, has previously labelled Ontario’s private-clinic plan, which was announced in January, as “innovation.”
Mr. Ford defended his government’s new bill on Wednesday, saying the changes in his proposed Your Health Act are needed to help catch up on a backlog of surgeries pegged at more than 200,000 patients.
Opposition parties grilled the government over the proposed expansion of private surgical centres, arguing it is a step toward two-tier health care in the province that will drain public hospitals of staff.
“When we took office in 2018, the health care system was an absolute disaster, there was hallway health care, it was just a total, total mess,” the Premier said in Question Period at Queen’s Park. “As we’re building the health care system, the opposition is blocking it every step of the way. They have no solution, Mr. Speaker, for the 203,000 backlogged surgeries. We have a solution.”
Official Opposition NDP Leader Marit Stiles accused Mr. Ford of creating a “crisis by design” in the health care system, worsened by underfunding hospitals and a legislated cap of nurses’ wages, which was recently overturned in court but that the government is seeking to appeal.
“Hospitals and long-term care homes are already desperately fighting to retain nurses and doctors in what is really a staffing crisis across the system, and they’re not going to face competition from new two-tier investor-driven clinics. Nothing in this bill prevents that from happening,” she told the legislature.
Mr. Ford countered that Ontario has added 60,000 nurses and 8,000 doctors under his leadership, arguing that the draft legislation would help take the burden off the backs of hospitals by moving more surgeries to other settings.
Ms. Stiles also expressed concerns about oversight in the new clinics, raising questions about who will inspect them and how patients can complain if they are sick.
Health Minister Sylvia Jones on Tuesday told reporters that while the bill includes enhanced oversight for private clinics, it does not specify what body would actually regulate them, or do inspections. The bill says a regulator would be named at a later date. Ms. Jones would not say what organizations were being considered for the job.
Liberal MPP and health critic Adil Shamji, a former emergency room physician, said the draft legislation has no details on how its proposed prohibitions against charging patients extra fees would be enforced. A recent report from the province’s Auditor-General that declared the practice, along with “upselling,” a widespread problem in existing private clinics that do eye surgery and other procedures.
Dr. Shamji’s party’s platform in last year’s election called for the establishment of similar specialty surgical centres outside hospitals – but said they should be non-profit. He told reporters on Wednesday that multiple studies show for-profit care results in worse outcomes for patients.
“We are not against this idea in principle,” he said. “What we are against is profiteering and creating a runway for corporate interests to come in and upsell patients, upcharge patients and leave our health system with inferior patient care.”
John Yip, the chief executive officer of SE Health, a non-profit that provides home-care services for seniors, said his organization is interested in setting up non-profit surgical centres under the new system. But he said the legislation leaves many details of how the new clinics will operate and be governed to be worked out.
The former president and CEO of the Kensington Eye Institute, a Toronto non-profit eye surgery centre, Mr. Yip said the new facilities would work best as independent entities from hospitals – but still inside the broader health system.
“Surgical centres should work within the system, not alongside it, to ensure equitable access for patients,” he said.
The government has not said how many surgeries it intends to shift to private clinics. Natalie Mehra, executive director of the Ontario Health Coalition, pointed to Mr. Ford’s remarks last month that 50 per cent of surgeries now in hospitals could be done elsewhere. That, she warned, would suck staff from the public system and gut many smaller regional hospitals.