Guest Blog by Doris Grinspun, RN, MSN, PhD, LLD(hon), O.ONT. Executive Director, RNAO
Dick Davis points to physicians, pharmacies and dentistry as examples of how there is nothing “wrong” with for-profit health care. With respect, it is the myth that somehow for-profit health care leads to better health outcomes that is wrong.
Those who must forego needed drugs because they have no drug plan, or suffer the stigma of poor oral health because they can’t afford costly procedures, or don’t have the money to jump the queue and seek “faster” service from a private clinic physician certainly know what is wrong.
In fact, the evidence is overwhelming that publicly-funded, not-for-profit and universally accessible health care works – it costs less and provides more.
Himmelstein and Woolhandler have reviewed four decades of experience with privatization in the United States. They found that “for-profit health institutions provide inferior care at inflated prices.” At a time when governments are looking to reduce costs, the finding that for-profit hospitals take an 18 per cent higher chunk out of the budget is sobering. The fact is that not-forprofit health care is a bargain for government and a winner for the public.
Private contracting in the U.S. Medicare program for seniors is a cautionary tale in that it evolved into a multi-billion dollar subsidy for HMOs who often cherry-pick the healthiest clients who cost less to care for, while refusing those most acutely and expensively ill.
In terms of quality of care, it’s no contest. Again, you can’t go wrong with not-for-profit health care. Considerable evidence is available on quality of care differences between for-profit and not-for-profit delivery across sectors. Studies show that the quality of care in for-profit institutions is lower. Patient mortality rates in for-profit as compared to not-for-profit centres are higher.
A compelling example is that patients attending for-profit dialysis had eight per cent higher death rates than those who received care at non-profit facilities. This translates into an estimated 2,000 premature deaths each year in the United States linked to for-profit dialysis. Furthermore, worse health outcomes have also come with higher costs: a systematic review and meta-analysis of peer-reviewed literature concluded that for-profit hospitals charged a statistically significant 19 per cent more than not-for-profit hospitals.
Canadian evidence from the long-term care sector has found that staffing levels were higher in not-for-profit facilities than in for-profit facilities, and health outcomes were better in not-for-profit facilities. A systematic review and meta-analysis published in 2009 confirmed that the evidence suggests that, on average, not-for-profit nursing homes deliver higher quality care than for-profit nursing homes. For a review of the above evidence, see:
While the research evidence demonstrating a relationship between publicly-funded, not-for-profit health care and better outcomes and lower costs is clear, that does not mean that the system can’t be improved. In fact, it must be transformed in significant ways. For example we must address key social and environmental determinants of health. All Canadians must have timely access to team-based primary care. Investment must be increased in home care services and community supports. Develop a comprehensive national home care and pharmacare strategy, and a strategy for mental health and addictions. Improve health outcomes through adopting clinical best practice guidelines. Utilize all health professionals to their full scope to improve timely access to quality care. These and more systemic and clinical innovations can and must be made. And, they are all achievable through our publicly-funded, not-for-profit health-care system. There’s nothing wrong with that!