Profit or Public Health? Really?!
Discrepancy raises questions about plans to do more surgeries outside of Ontario's public hospitals
Premier Doug Ford's government gives a for-profit clinic more funding to perform certain OHIP-covered surgeries than it gives Ontario's public hospitals to perform the same operations, CBC News has learned.
Ontario's government has never before made public the rates it pays a private clinic in Toronto to perform thousands of outpatient day surgeries each year.
Through a freedom of information request, CBC News obtained documents that reveal those funding rates for the first time. You can see one of those documents for yourself at the bottom of this story.
Four senior officials who work in different parts of Ontario's hospital system reviewed the documents, and all four say the rates being paid to the privately-owned Don Mills Surgical Unit Ltd. are noticeably higher than what the province provides public hospitals for the same procedures.
That discrepancy raises questions about the government's imminent plans to expand the volume and scope of surgeries performed outside of hospitals, including the potentially lucrative field of hip and knee replacements.
Ford and his health minister have pitched this expansion as a cost-efficient way to get more surgeries done and reduce wait times.
However, many health-care professionals are concerned that outsourcing more surgeries to privately run for-profit clinics would merely shift resources from Ontario's hospitals and boost clinic owners' revenues, without actually shortening wait lists.
The documents show provincial agency Ontario Health contracted Don Mills Surgical Unit Ltd. at the following per-surgery funding rates in each of the three fiscal years starting from 2020-21:
$1,264 for each procedure classed as minor complexity (such as cataract surgery)
$4,037 for each moderate complexity surgery (such as a laparoscopic gallbladder removal)
$5,408 for each higher-complexity surgery (such as repairing a large tear of a rotator cuff).
The funding rates do not include how much the surgeon bills OHIP for each operation. The physician's billing for a particular OHIP-covered surgery is identical whether it takes place in a hospital or a private clinic.
'Egregious' overpayment: chief of surgery
In separate interviews, senior public hospital officials who reviewed how those rates applied to the 70 different surgeries on the Don Mills list said the province provides their hospitals less funding per surgery for identical procedures.
The officials spoke on condition of anonymity because they feared talking publicly about the province's funding arrangements could bring financial repercussions to their hospitals.
"The overpayment for these minor things is egregious," said the chief of surgery at a large Ontario hospital. "It doesn't look like great value for money."
The $4,037 of funding allotted to Don Mills Surgical Unit (DMSU) for each moderate complexity surgery is "very generous" compared with how hospitals are funded for comparable operations, the chief of surgery said.
A director of surgery at another hospital says those funding rates would allow significant profit to flow from the public purse to the clinic's owners.