On Wednesday May 10, Sara Labelle, chair of OPSEU's Hospital Professionals Division, presented to the Standing Committee on the Legislative Assembly at Queen's Park on Bill 87, the Protecting Patients Act. The amendments proposed in this legislation will have far-reaching implications for the provision of community laboratory services in Ontario, including the introduction of a competitive bidding system.
Here is the full transcript of Sara Labelle's presentation:
Patients, not profit: strengthening Ontario's community hospital labs
Thank you for the opportunity to present today on Bill 87, the Protecting Patients Act. My name is Sara Labelle, and I am the Chair of OPSEU’s Hospital Professionals Division. I am also a Medical Laboratory Technologist by profession and work at Lakeridge Health in Oshawa.
While there are several aspects of the bill worth exploring, I’ll take this opportunity to focus on two specific amendments to the Laboratory and Specimen Collection Centre Licensing Act, which impact the Health Insurance Act and the Public Hospitals Act, by expanding the role of community hospital labs and changing the community lab funding model (or rather the way the government pays private (and more often than not, for-profit) laboratories in this province.
Expanding the definition of “community lab services” to include hospitals
Bill 87 would allow community hospitals to provide lab services to individuals that are not inpatients nor outpatients of the hospital (previously considered “community laboratory services”). The Minister can also now designate hospitals to provide community lab services.
Community hospital labs should have the ability to provide community laboratory services. In fact, it is our argument here today that community hospitals should provide all laboratory services. But we are concerned.
Firstly, we are concerned about the increased pressure this plan will put on already-overstretched community hospitals. Secondly, we’re concerned that this amendment is focusing in on northern and rural hospitals for the wrong reasons. We’ll come back to this point in a moment.
But finally, we’re concerned because the government should be working to bring all laboratory services under the umbrella of public medicare, like what’s happening right now in Alberta.
Historically, lab services were housed in community hospitals. Hospitals, after all, are the public, non-profit, health care hubs within our communities. All of us at some time or another will require hospital services, and most likely, we’ll need hospital laboratory services as well.
Ontario’s hospitals are at a breaking point
How can our hospital labs take on more responsibility when Ontario’s community hospitals have been pushed to the breaking point? We have endured nine years of deep and devastating cuts to hospital beds, services and staff. No peer jurisdiction has undertaken such radical cuts to community hospitals, and by virtually every measure, Ontario now ranks at the bottom of comparable jurisdictions on hospital care levels. Our hospital labs have been decimated.
The recent Ontario Budget doesn’t go anywhere near far enough in undoing the damage that’s been done. And our community hospital labs cannot, I repeat, absolutely cannot take on more work, without the proper funding to match it.
The end of fee-for-service
The second matter I want to discuss today is the fee-for-service funding model.
Fee-for-service is a highly flawed method of payment. It benefits for-profit corporations that set up in urban areas where high volumes are easily achieved and it’s detrimental to small, rural and northern communities where services are regionalized to make the volumes worthwhile financially.
An elite few have managed to make a lot of money under this model, on the backs of regular Ontarians. In fact, in Ontario, two corporate entities have been permitted to hold 95 per cent of the community laboratory market.
While we would be thrilled for the government to walk away from a fee-for-service model to a fully public funding model, that doesn’t appear to be the government’s goal here.
Based on recommendations this government received from a so-called Laboratory Services “Expert” Panel report in 2015, they may be moving away from the fee-for-service model, but likely to open the door to a competitive bidding model (or in their words, “transfer payment agreements”).
While we are not completely surprised by this move, we are deeply disappointed. This government needs to understand that there is no place for privatization and profit-taking in our public medicare system.
But coming back now to the point I began making earlier about northern and rural communities: with lower populations and vast tracts of land, competitive bidding is not an ideal model in rural and remote regions. We’re concerned that the amendment to allow hospitals to take on community lab services is not being done for the right reasons. Instead, we are concerned that it is a “safety valve” so that in regions where the competitive bidding process fails, those community laboratory services can be delegated to the local community hospitals, who are the tried and true providers of public health care.
Public = Better
Competitive bidding is not the solution. Competition does not drive efficiency or provide quality care at a lower price.
Just look at the research done by Ross Sutherland, expert and author of False Positive: Private profit in Canada’s medical laboratories. By the most conservative analysis, for-profit labs cost the Ontario health care system at least 25 per cent more.
If you want to see value for money, look at the 2007 results of an Ontario pilot project in which RPO Management Consultants determined that costs at public hospitals averaged $22 per test, compared to $33 for the same tests in the large for-profit labs.
By Sutherland’s analysis, the Ontario health care system could save between $175 to $200 million per year by integrating community lab services with hospital labs.
If the government’s priority is patients, it’s time to stop the flow of public dollars into private hands, and this includes moving to a competitive bidding model in the lab sector. All community lab services should be fully integrated into our community hospital labs, which are the public, non-profit health care hubs in our communities.
To view OPSEU's full Bill 87 submission, click here.