CareSource Solutions Inc. is an example of a new breed of British Columbia firms that are experimenting with for-profit health care delivery. These companies tend to operate without much fanfare but recently found themselves in the middle of the province's latest battle -- the strike by the B.C. Hospital Employees' Union.
On Sunday, the province legislated health care employees back to work and it took the B.C. Supreme Court to narrowly avert a general strike. The flashpoint in the dispute between health workers and the B.C. government was a 15-per-cent wage and benefit rollback and the use of contract workers.
On the surface, the dispute was a clash between union and non-union ideals. Unfortunately the rhetoric clouded the larger economic story, which is about how British Columbians choose to have their health care services delivered.
Discussions about contract workers set unionists' teeth on edge and tend to devolve into a heated debate about the dangers of "privatized" medical care. And in a country where popular discourse still uses the language of "public" and "private" to discuss what is in effect a private health care system, resolution isn't around the corner. According to the Romanow Commission, while 70 per cent of Canadian health care is financed publicly, almost all of that care is already delivered by private, usually not-for-profit providers.
The argument against outsourcing is that it erodes wages, hard-won pay equity gains and quality of care, while the argument for contract workers is that they save money, a plus given the provincial health care financial squeeze.
Tensions are so high surrounding this issue that, ironically, in a province where marijuana is grown and sold readily, contract workers often operate underground in fear of union retaliation.
For instance, Vancouver-based CareSource, which supplies contract care aides to long-term B.C. health care facilities, doesn't advertise and tends not to discuss business even though the lack of visibility can affect its ability to win contracts. "The environment is such that it is a bit confrontational," says Ken Sim, a former investment banker, who is a partner in CareSource. "We don't advertise but everyone knows who you are."
The demand for contract workers has grown in B.C. over the past year as an estimated 5,000 full-time HEU positions have been eliminated, largely in the food service, housekeeping and maintenance areas as well as some care aides. However, Sunday's deal with the union capped the number of contract jobs at 600 positions for the next two years.
Compared with B.C., the involvement of for-profit firms in Ontario is common in many health subsectors, such as nursing homes, home care and contracted-out services in hospitals, says University of Toronto health policy professor Raisa Deber.
Examples of small businesses operating in the health sector range from physician offices and rehabilitation clinics to investor-owned corporations. Corporate players include large food service companies and medical testing firms.
One of the main problems with for-profit health care delivery is the fact that data surrounding the operation of the company becomes proprietary. As a result, it is more difficult to measure the costs and benefits for taxpayers. The benefits can be seen in the food service sector, where firms that specialize in the delivery of a service that is unrelated to health care, have moved in to manage that area, benefiting from economies of scale.
Another issue relates to wages, which tend to be lower than not-for-profit, unionized work, which causes increased turnover. Past efforts to cut wage costs for skilled workers, such as lab services, physiotherapy and nursing, who are in high demand, have resulted in for-profit firms having to raise wages for these groups, which has shown that this strategy is not very sustainable, Dr. Deber says.
Too many questions with too little data characterize this health care debate. Despite this week's deal capping the amount of contract health workers in B.C., it is clear the province is moving in the direction of a higher ratio of firms in for-profit health delivery. For instance, 7,000 of the 25,000 long-term-care beds in the province are currently run by for-profit firms.
Public discussion has to move from the fruitless debate between public and private health care in order to come up with decisions that make the most sense.
Mary Lynn Young is an assistant professor at the University of British Columbia's School of Journalism.