When Ontario Premier Doug Ford recently reflected on potential provincial health care reforms, he cited Shouldice Hospital as an example of the positive role privatization could play.
His praise of the world-renowned private hernia clinic, one of the few Ontario hospitals allowed to operate for profit, also raised the question of whether this is a model that could be replicated or that would lead to erosion. of medicare and the creation of a two-tier system.
The hospital, in Thornhill, just north of Toronto, is located on a 20-acre country estate, complete with gardens and walkways, making it feel more like a spa, 89 licensed beds, and five operating rooms. The menu includes appetizers such as rainbow trout with hollandaise sauce, roast potatoes and green beans or coconut chicken and curry with Singapore noodles.
A former patient recently joked on Facebook that he keeps checking for “another hernia so I can have another mini vacation”.
However, the hospital’s main claim to fame is the number of hernia surgeries it performs, around 7,000 per year.
This means that, according to the hospital, its surgeons repair more hernias in a year than most others over a lifetime.
“Our surgeons and surgical team are second to none,” John Hughes, chief executive of Shouldice Hospital, told CBC News in an email. “Since our surgeons only perform hernia repairs … they are simply excellent at what they do – what you do more improves you.”
Shouldice also claims that its model allows it to operate at a lower cost per case than public hospitals and that waiting times are a fraction of that of the public system.
The hospital also says its infection, complication and relapse rate is less than 0.5% for primary inguinal hernia repairs, the lowest recorded in the world.
The surgeries themselves are covered by the Ontario Health Insurance Plan.
Outside of this “we charge a semi-private room at a rate in line with the rest of the [Toronto-area] hospitals, “Hughes said.” There are no additional costs for other services, such as doctors, food, drugs.
But due to the hospital’s policy that most patients must stay at least three days or more after surgery, those room charges generate significant revenue, critics say.
“Many people who go there go there because they have very good private insurance,” Ontario MPP France Gélinas, a health critic of the NDP, said in a statement.
Founded in 1945
The hospital was founded in 1945 by Dr. Edward Earle Shouldice, who performed hernia surgeries for the military during World War II, according to his grandson Daryl Urquhart.
“In At the end of the war, there was this formation of people willing and willing to repair their hernia. And there was a shortage of hospital beds. And so my grandfather decided that the best way to handle the situation was to open a hospital, ”said Urquhart, who is also a former co-owner and former director of business development at Shouldice.
Its first location was in downtown Toronto, but as it became more popular, it moved to Thornhill, on the estate of George McCullagh, a millionaire miner and newspaper publisher, who bought the Globe newspaper and the Mail and Empire, combining them for create the Globe and post.
The main residence of the estate has been converted into a hospital. In 1971, the province’s Private Hospitals Act was amended to ban any new private hospitals, but those already operational were relocated. There are only three private for-profit hospitals left in Ontario and one is Shouldice.
His patients have included politicians and prominent figures, including former Prime Minister Joe Clark, US consumer advocate Ralph Nader, and US Senator Rand Paul.
In 2006, it sparked controversy for NDP leader Jack Layton, a critic of private health care, who was accused of hypocrisy after admitting he was a patient there in the mid-1990s. (Layton said he didn’t know it was a private hospital.)
Urquhart says Shouldice’s specialization model produced an efficiency and skill set not available elsewhere.
“You simply can’t get higher level efficiencies in a general factory than you can get in a targeted factory,” he said.
The model can be replicated
He says the model could be replicated, but it would require targeted action by specialized medical professionals.
“It has to be a concerted effort between professionals and administrative and bureaucratic staff. And that kind of action typically occurs in the private sector, not the public sector,” he said.
But Dr. Hasan Sheikh, vice president of Canadian Doctors For Medicare, said there are “wonderful examples” of nonprofit surgical centers that perform high-volume operations for specific ailments.
“And without that profit motive, they are able to deliver extremely efficient, high-quality care,” he said, citing the Kensington Institute in Toronto, which specializes in eye surgery, as a “prime example.”
“There’s a comfort in sending people to a place that does one thing and one thing only. And I think, you know, there’s no reason why that has to happen in a for-profit delivery model.”
The patient remains questioned
The Sheikh also wonders if hernia patients should really stay at Shouldice for a few days after an operation.
“One of the big concerns I have is the fact that for a hernia repair – which is a fairly straightforward operation and in most public hospitals it’s a daytime procedure – in Shouldice, those patients will be staying for three nights.
“Keeping people doing the same procedure longer doesn’t seem particularly innovative,” he said. “And I think when you have this profit motive … the question arises of whether these decisions are made based on what’s best for patients.”
Gélinas, the health critic of the NDP, says that thousands of hernia operations are performed in hospitals in the province by hundreds of general surgeons.
“And everyone is recovering and everyone is satisfied.”
Gélinas also says that, with only a limited supply of general surgeons in the system, the more people who go to private clinics means the less “they are available to the rest of us.”
“Private for-profit clinics will cost us dearly,” he said. “It is deeply troubling that Mr. Ford mentioned Shouldice as a role model to look forward to.”
However Urquhart defends the hospital’s three-day policy, stating that it reduces patient anxiety and leads to fewer potential complications.
“You’ll have people saying ‘They don’t need to stay. Shouldice just need to make money and so on.’ And that’s not true. If Shouldice were to send patients home the same day or the next day, they would just put more patients through the system. “
“It makes no difference. The most important thing about the model has always been what is best for the patient.”