Who wins when provinces contract health care? | About That

under this government's watch people across this country are spending money out of pocket for surgeries thirty thousand dollars for hip surgery when will this government finally stop American style health care from entering our country the choice I had was to register with ohip and hope that maybe you have the operation in six months or go to a private Clinic which I did and I had both my eyes fixed in six weeks I'm Andrew Chang welcome to about that Healthcare it's not in great shape in this country and and you know there's been a lot of

discussion in the media lately about private versus Public Health Care and you know it's no surprise people are are waiting months and months sometimes even longer than that for simple surgeries and they're sort of feeling desperate for options and some think that opening the door to private care is going to fix our broken Health Care System others say hold on Private health care is fundamentally wrong and we shouldn't allow people to pay for care essentially you know butting in line jumping the cube just because they've got money but what sort of gets lost in this

whole conversation is what private Health Care actually generally looks like in this country and and where provinces are actually taking this conversation so let's start with this according to a statistics Canada survey in 2021 almost half of adults across 10 provinces had difficulty accessing Health Care in 2020 and 2021 close to 15 say they didn't receive the care they needed at all and in some parts private clinics have moved in to try to fill that Gap so you know in BC some elective surgeries like hip and knee Replacements Diagnostic Imaging so you know on that

front we're talking like CT scans MRIS and other procedures you know they they routinely get contracted out to private clinics uh both Manitoba and Saskatchewan are attempting to deal with backlogs by paying private clinics outside the province to do surgeries and last month Ontario unveiled a plan not entirely unlike BCS where more surgeries and diagnostic procedures would move out of hospitals and into private clinics Ontario's Premier says working with private clinics will help the Public Health Care system to start we're tackling the backlog of cataract surgeries where we have some of the longest waves and

Doug Ford insists that won't mean paying out of pocket all of these Services they'll be available using your ohip card never your credit card so cataract surgeries to start but branching out into other elective surgeries as time goes on and and the basic idea here is to lower wait times right by by kind of opening up this separate Health Care pipeline but still within the public system just using private resources but paid for by taxpayer dollars now this is not the easiest thing to understand but we have just the right person who can help explain

all of it to us and and give us a good sense of why you know even the most optimistic people are saying we should tread carefully on this CBC Health reporter Christine Burak how you doing good to be here yeah no hey thanks for being here so we've got a lot to talk about and I guess like let's start just by setting the terms because when we talk about Private for-profit health care in this country we're not always talking about the you know the extreme end two-tier Healthcare jumping the queue I get the best health

care just because I've got the most money it's it's actually quite a bit more subtle than that right absolutely so yeah let's try and break this down I do think that in order to better understand it you do have to follow the money to some degree and figure out who's paying for what so I think just as a starting point you have to understand that pretty much most doctors are all private independent contractors who get paid for a service right they get reimbursed exactly for example and it kind of depends on who's paying them for

that service that that makes a difference so I'll give you an example let's say you need knee replacement surgery and you end up in a hospital to get that knee replacement surgery the province pays the hospital a fee to do your knee replacement surgery and an average an average price in Canada is about ten thousand dollars so that includes the surgeon whatever you need for the knee replacement the staff that's there the hospital the hospital gets ten thousand dollars and I as a patient wouldn't be out of pocket nope you do not pay for anything

in that instance but let's say you want that knee surgery you want it right now you feel like I can pay for this I don't want to wait at all you could go to another Province and you could get that knee surgery right away our research shows that it caught it will cost you the patient up to twenty eight thousand dollars to do it that way so so significantly more money that I'm out of pocket but I entirely skip the line I can just get the surgery when I want to get it exactly right so

now we come to what you're describing and that is the provinces are willing and we always say Province but this is taxpayer dollars let's just remember we are all agreeing um that the hospitals are full or overwhelmed and so let's take out some of these patients and we're going to pay for their procedure in a private clinic so we asked okay well so what happens when you want to get your knee replacement now in a private clinic so how much does that cost right but it still costs nothing to me because this is still within

the public system right well it shouldn't in theory cost you anything yeah and we'll get into that because BC has seen different outcomes as a result of this but yes so in theory you know that whole idea that you're going to pay with your health card not your credit card you go into the clinic you get your knee replacement surgery and we wanted to find out well how much does that cost taxpayers or how much is the province then paying and that information is actually kept secret we cannot find out how much the province pays

a private for-profit Clinic to do your knee replacement surgery um that's kind of an important piece of the puzzle to know though it is but the the clinics themselves say hey this is part of confidentiality The Province also blocks us from accessing that information saying that it's part of contracts that we have and our question in this for sure and to your point is that well where's the accountability for taxpayers right how much exactly are we paying into these for-profit clinics and you know I think it's important to note that the difference and this is

a question that some people might be asking why does it cost ten thousand dollars if you get it in the hospital but twenty eight thousand dollars if you get it in the clinic and really the difference is profit how much are people making on the back end of this okay so so so I can accept that this is sort of a big piece of the puzzle that we just don't have right now right what the cost of the province would be in this sort of public private hybrid model but but do we know enough about

how we would work to know whether it would work right like what's the argument here so so if you it you you Outsource some of these these services and surgeries to the private sector paid for by the public system um like what's supposed to happen when you do that right so the expectation is is that you know we sort of attach a lot of things to the word private we kind of think that it's going to be be and and I think sometimes this is promoted that it's going to be more efficient financially is it

going to be cheaper you know what if we get people out of line and and get them into these clinics we'll make the lineup shorter so is it faster which uh evidence is shown we haven't really seen it work out that way but overall and this is what I thought okay let's say even if provinces are paying more we want people to get their surgeries so are the wait lists shorter and ultimately that's what we want is people to get their surgeries faster and so Ontario has said Hey listen we are following the lead of

BC Alberta Quebec and they are doing a lot of these surgeries as it is in these spaces right so we're talking about as you mentioned cataracts hip replacements knee Replacements things like that those are the surgeries that are that are largely backed up so we thought okay if BC has been actually doing this for the better part of two decades let's take a look at waitlists so there's the Canadian Institute for health information has data on how long Canadians are waiting in very his provinces for various procedures so we took knee replacement surgery as an

example and as it turns out when we looked at the data Ontario actually has shorter wait times for hip and knee replacement surgeries than Quebec BC and Alberta then then some of those provinces who have been Outsourcing to the private sector for as you say years if not decades so that struck us and we're not talking huge differences here we're talking that you know I I believe in Ontario seven upwards of 70 percent of people get their knee replacement surgery within six months and in BC it's about 68 okay so so but explain the logic

there like like how that works because like if I understand the theory correctly it's by opening up this other stream where you can divert patients away from hospitals and such in the private the public system into private clinics you're you're freeing up the bottleneck right you just have more people who have more choices you the throughput is is greater wait times go down so so how is it that so here's what I think and and I completely see where you're coming you're coming from right now because I looked at it the same way but there

is a logic problem in here somewhere because so we we talked about the fact that we don't know how much it's costing now I'm telling you that wait times actually are are shorter in Ontario as it is without these clinics and I started to think well well why exactly is that happening and the the interesting thing here is that we kind of think that these a knee and hip replacement surgeries they're not minor surgeries but they're less complex surgeries than a lot of what happens in the hospital and you kind of think to yourself well

let's get those people out of line just like you said and then we'll make room the issue here is Staffing you know at the well actually I'll back it up one thing because another part of the issue here is that we kind of think that if you open more clinics we have more operating rooms yeah it just have more capacity exactly there will be more capacity and there's logic in there to think if there's more capacity then we can do more surgeries we'll get people through the system faster that's right so I went to go

see the head of surgery at Women's College we sat down in late in the day in an operating room and I said the same thing I said but if there are more operating rooms we can do more surgeries and that'll move through people through faster and he looked at me and he said Christine we are sitting in an operating room right now that's not being used right you could use this operating room and he's like we could run these operating rooms 24 7 evenings weekends you know surgeons could come and and work in these rooms

he says the problem is in spaces it's people the limiting factor right now is not places we don't need new places we need people we really the bottleneck right now is is particularly Nursing Care in some areas it's it's respiratory therapists it's an esthetist to a to a certain extent we've got lots of facilities and we can use all of these existing hospitals if we had the people so we have to have trained nurses who are able to work in these hospitals and we also have to have funding to be able to to uh to

pay them and to support all the other needs that happen in hospitals okay so you don't have the nurses so what happens when you open private for-profit clinics and he said well therein lies the big problem you're pulling people away from this public system it's the same pool of nurses and doctors and and we don't create health care workers I mean there are people who are graduating but you can't suddenly have you know a whole lack more of doctors and nurses so there's a pool and now suddenly let's say somebody's offering you twice as much

money to go work in a for-profit clinic right right so I don't think you can stop a nurse or a doctor or surgeon from saying oh wow like somebody's willing to pay me twice as much over here so they get out of the public system or you know and and go work on that side well now the pool is shrinking for the hospital of staff and we've already taken out a lot of the less complex procedures what's left over here are more complex procedures fewer people to do more difficult fewer staff um I have many

more questions for you because I also do want to talk about Solutions at a certain oh absolutely um Christine Burak will be back with us after this foreign [Music] you could do operations in this operating room you don't need to open up new facilities and he says hospitals are only funded to do a specific number of surgeries per year governments could pay to schedule more on evenings or weekends but the real issue is Staffing we need people we really the bottleneck right now is particularly nursing care but for-profit clinics recruit nurses from the same pool

of workers a nurse or doctor leaving for more money leads to longer wait times in hospitals I really worry that people don't completely understand the long-term impacts of some of these changes hey welcome back to about that we are indeed talking about Public Health Care uh in this country and where Public Health Care meets Private health care and and whether a hybrid model which which is something that many provinces are sort of increasingly turning to as a potential solution to our health care crisis in this country whether that hybrid model actually introduces the sorts of

efficiencies we would expect and Christine Burak CBC Health reporter has been walking us through this and we're talking about wait times just before we took a commercial break there and how we found that wait times even in provinces where this private model has injected itself into the public how they kind of just stay the same which is sort of surprising they do and in fact there's evidence that actually the way wait times get longer because they've lost staff and so now people need to wait longer for more complex surgeries in the public system so there

is this sense that I mean where where are the gains here what are we supposed to be gaining when we do look at I mean so that's that's the public side of it or the public facing side when I look at the private clinics tell me more about that because I don't know when I imagine a pride and this is just stupid me thinking right with my Layman understanding of things but like like when I think of a private Clinic I think well this is going to be a fancier facility it's it's going to be

sort of like flush with cash and so that kind of goes back into the care and and as a patient I will have a better experience and and maybe even better outcomes as a result like is that the case I think those are those it's really good points because I think that there is a perception that that's how it works but I think we're sort of losing the understanding of what for-profit I mean people say private but it's really for-profit and at the end of the day these clinics exist to make profit yes they are

doing care but at the end of the day they wouldn't exist if they weren't making profits so I think actually a really good example of looking at this in Canada is long-term care so that long-term care in Ontario especially specifically used to be all public and it was brought to they started to Hive it off and allow for private care so in those facilities you know people still feel that you know in private care exactly what you describe but we saw during the pandemic that what for-profit care meant was the you know there were more

patients in a room there was less Staffing there were higher death rates in private for-profit Long-Term Care Homes than there were in public homes studies of the UK and U.S have also shown private for-profit care can lead to slightly higher death rates so when we're looking at private findings sending in our system in multiple examples it tends to have worse patient outcomes and tends to have more financial inefficiencies so why would we be looking to expand that aspect of our existing health system and we've also seen studies that look at death rates in for-profit care

and and I don't want to be alarmist in any way it's that they're higher it preventable deaths have been found in studies to be higher in the UK where they've introduced it and in the United States where the model is is full-blown so I mean there is this sense that if there can be efficiencies I haven't been able to see exactly I didn't find we don't know how much they are costing taxpayer dollars in terms of being cheaper in terms of being faster we don't see wait lists go down and in terms of being safer

um you know there would have to be a whole new regulatory body in Ontario which Ontario has not said how we're going to actually police these new clinics and make sure that they have the same standards as hospitals right because hospitals have very high standards right absolutely yeah or they're constantly being checked so if so so if this introduction of the private system into the public system doesn't necessarily grant us efficiencies on those three fronts that you just mentioned not necessarily cheaper not necessarily safer not necessarily faster like that sort of leaves me wondering okay

so so now what Christine Iraq right right yeah where do we find the efficiencies that we're looking for and that we need in this country and so I think that that's a bit of the frustration that some of the doctors that I spoke with are having they feel that there are they're not sexy Solutions like you know use your ohip card or health card to pay for stuff they're actually operational things that happen within hospitals and the connectedness of some of these resources but one of the big ones in terms of surgery so when we

look at surgeries in particular I asked um I asked doctors surgeons you know how well how can we make this system better if it's not moving some of these surgeries out how do we the first thing they said is actually the provinces could fund more surgeries within the hospitals so this isn't something that I realized but hospitals are only funded to do a certain number of surgeries per year even though we can largely predict based on history and age of population how many surgeries are going to be needed there isn't really the work going in

to make these predictions more of a you know a match and as you said there is capacity there there is if there was funding to do more right the Staffing is still an issue sure but another thing that they brought up was centralized waitlist so we are often talking about these huge wait lists and I had a surgeon say to me there's no wait list Christine every surgeon has their own waitlist so let's say you go to the doctor you need a specific surgery your doctor refers you to a surgeon who has a very long

wait list now all of a sudden you're on a very long I'm just stuck on that list you are but let's say I go to my doctor and he sends me to another surgeon who actually has a very short wait list so I end up getting my knee replacement surgery before you do but wait wait wait so there's no mechanism where those two surgeons would talk to each other and say and your doctor can't even see their weightless has no idea who has the longest waitlist or who has the shortest waitlist well that seems silly

it does so the Ontario medical association and we've seen this happen we see it happen in smaller groups where there should be a centralized wait list kind of like a call center it's like all of these calls are coming in and you get the next available operator or you get the next available surgeon and it's like well okay so your request is your your referral has gone in Andrew there is a surgeon at uh you know maybe it's even a little bit farther away but maybe you're willing to travel that far and you want that

surgery right away now it would make sense that you then it's a system that's just far more efficient it just sends you to the next available search rather than sitting on a waitlist we asked well what's the opposition to this and we were told by a surgeon often it's surgeons because they like to hold on to their wait list because their wait list is a guarantee of income and in a fee-for-service model which means you get paid for every patient that you see you want to know that you have the security of my income is

here what doesn't make sense in there is that there is so much work right now that they don't need to be holding on to these wait lists and you'll also hear from patients who'll say well then how do I get to choose my surgeon and I think that's what's interesting in a lot of these discussions is that there is a small percentage of people I'd say up to 10 percent that are sort of you know uncomfortable about some of these changes but it's affecting everybody else at the same time and so I mean for people

who do want their own specific surgeon we could probably work that out but this system needs to change and in terms of the operational like the communication between hospitals all of these things need to be upgraded and I spoke with an expert who said this is a health policy expert so not a doctor and he said you know if you look around the world our system is not working well right now if you can get 60 of people happy there is no perfect system the highest approval ratings we have ever seen for healthcare are around

60 so we shouldn't be tearing down what actually works really well we should be building on top of what is actually the most cost efficient the safest and the most uh time effective in getting people's surgeries they need Christine Burak we have come so far and and yet only just scratched the surface such a wonderful conversation thank you so much very welcome and uh we'll be right back after the break with a little sneak peek at something we're working on for tomorrow's show [Music] hey welcome back to about that just before we close out the

show for today thought we'd give you a little sneak peek at something we're working on for tomorrow because on Wednesday we're expecting the CEOs from three major grocery store chains in Canada to appear before a parliamentary Committee in Ottawa that is looking into the high prices that we pay at the grocery store and grocery stores were talking about Loblaw we're talking about Metro and Empire which owns sobies and IGA and a few other companies so we thought we'd ask how did we get to this point so here's what I did I looked up statscan data

from the last year and and this is a list of more than a hundred different products that we might buy at the grocery store so you know everything from milk to frozen pizza to Yogurt potatoes tomatoes canned goods vegetables fruits meat you name it and what I did was I looked at the prices that have increased the most over that time just so we can get a sense of how how things have changed and then we went and bought a whole bunch of those things to see what the prices are today in Toronto and so

tomorrow what we're going to do is we're going to look at which of these items have actually increased the most we're going to try to explain why that is and then we'll look at how accountable the grocery store CEOs may be held on Wednesday we'll see you then [Music]