CUPE > [CUPE healthcare list] private clinics

"Irene Jansen" <ijansen@cupe.ca> · Tue, 10 Apr 2007 07:04:57 -0400

Below, a statement from two orthopaedic surgeons supporting public sector solutions to wait list problems.

Attached, coverage of Godley's reopened for-profit emergency room in Vancouver.

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A simple-minded solution; Turning to private hospitals for surgery will only hurt health care
Hamilton Spectator 
Tue 10 Apr 2007 
Page: A17 
Section: Opinion 
Byline: Dr. Justin De Beer and Dr. Anthony Adili 
Source: The Hamilton Spectator 

Sometimes, what sounds like common sense is merely simple-minded. 

As senior orthopedic surgeons specializing in joint-replacement surgery, it is evident to us that the recent enthusiasm for private hospitals to carry out joint replacements provides an exemplary case in point. 

A for-profit hospital has sent a proposal to the Ontario Ministry of Health to do 1,800 knee-replacement surgeries. The ministry has turned down the private clinic, choosing instead to move ahead with its planned investments in the not-for-profit hospital system. 

The news media received the story. Headlines have blasted the government for not adopting this common-sense "solution" to provide waiting seniors with faster knee surgeries. 

Makes sense, right? And, to boot, a quick look makes the for-profit proposal appear less expensive than surgeries at not-for-profit hospitals. Perhaps it might be so, if knee surgery was comparable to producing widgets. 

In fact, there are a number of different types of knee surgeries, and patients come in with an impressive array of unique needs. As a result, we need to address a number of issues when we evaluate the consequences of providing surgeries in for-profit clinics or hospitals. 

These criteria include the types of patients they propose to treat, their quality of care, the true cost differential relative to not-for-profit care, and the impact on the supply of surgeons and nurses in existing non-profit hospitals. 

Typically, for-profit clinics and hospitals make money by choosing the less sick and complicated patients -- a phenomenon known as cherry-picking. No diabetes, no heart disease, no kidney failure, and so on. In rejecting complex patients, the for-profit care providers make it much more likely surgery will go smoothly, and most patients will have a short length of stay in the hospital. Thus, their costs appear low relative to hospital settings, where the mix of patients includes those with more complex health issues. 

There are other potential less-than-desirable consequences of surgery performed in for-profit clinics. If patients are pushed out the door on Day 1 or 2 after surgery, they may arrive back in emergency on Day4 or 5 with a heart attack or a blood clot developing in their legs or with an infection. 

Since the for-profit clinic does not have an emergency room, it won't be there where the patients return. It would be the not-for-profit hospitals that would have to bear the consequences (and the costs) of these complications -- another reason the for-profit hospitals may look, on the surface, less expensive. 

Teaching hospitals, as a comparator, must also bear costs of training young doctors. Learners tend to introduce "inefficiencies" at multiple levels, but without them -- as the current physician shortage has demonstrated -- health care would have no future at all. 

For those in search of more thoughtful solutions, the real wait-times issue is the number of anesthesiologists, operating room nurses, and orthopedic surgeons. Shortages of these key personnel are the current rate-limiting step in further output. 

The increasing demand for orthopedic services (hip, knee, shoulder, back, foot and ankle procedures) will only make this problem worse. Exploring ways to maximize the efficient use of our current personnel makes more sense to us. Those can include providing for anesthesiology and physician assistants and staggered start times that could allow one surgeon to run two rooms concurrently, thereby doubling his/her output. 

Our concern is that private clinics would likely harm, not help, health human resource supply issues. We wonder where an expanded Don Mills Surgical Centre would secure their workforce? 

This private clinic would entice doctors working in not-for-profit hospitals to give up other procedures to do joints in Don Mills. The result -- further lengthening of wait lists for all other orthopedic services. 

It may not appeal to the for-profit health care industry, nor their advocates, but the evidence from systematic summaries of high-quality studies that compare for-profit and not-for-profit care, is definitive. 

Ultimately, private surgical centres cost more, compound problems of coordination, diminish supply of scarce personnel in the public system, skim the easiest cases, and overall have the potential to lead to poorer health outcomes. 

It remains our concern that a for-profit knee-replacement operation, such as proposed for the Don Mills centre, is an apparently simple solution that could actually push up total costs of care and further suck desperately- needed doctors and other health-care providers from our publicly-funded hospitals. 

Health care needs more doctors and nurses, and it needs innovation and creative problem-solving. It is our contention that a wise government should invest in the nonprofit sector, and allow the brightest and best among those who are committed to patients, not profit, to lead those innovations. 

Justin de Beer and Anthony Adili are orthopedic surgeons with practices in Hamilton. 

© 2007 Torstar Corporation 

Illustration:
* Photo: TORSTAR NEWS SERVICE / A proposal to allow knee replacements in a for-profit hospital would drive up costs and hurt care in the not-for- profit system, say two Hamilton surgeons.

Edition: Final 
Story Type: Opinion 
Length: 780 words 