Open Letter
March 17, 2006
Dear Premier Dalton McGuinty:
Funding for hospital redevelopment in Ontario should give the best value for citizens’ tax dollars. Hospitals should be under democratic governance and operated according to the principles of the Canada Health Act.
The funding mechanism promoted by the government, ‘Alternative Funding and Procurement’, presents several problems. AFP is a version of a Private Public Partnership, or P3, in which for-profit consortia take over financing, construction, facility management, maintenance and some hospital services for long term deals stretching up to 40 years. They often seek additional revenue through commercial land deals on the public hospital lands, and service charges or user fees for patients and their visitors.
We are deeply concerned about the government's plans to impose P3s on our hospitals. P3s have proved to cost more and to result in compromised services. In the UK, the facilities funded through P3s have ‘almost invariably provided less capacity than those they were intended to replace.’ (R Atun, M McKee BMJ 2005;331;792-793)
Information provided to the public about P3s is frequently inaccurate. The December 2005 newsletter of Hamilton Health Sciences says about the hospital expansion and redevelopment projects in the city that 'the private sector will take on the task of designing and building as well as the financial risks of ensuring that the project comes in on time and on budget. Hospitals will remain publicly owned, controlled and accountable. The government’s decision to use the AFP approach to financing means we will be able to offer state-of-the-art programs and services for our patients in great new facilities much sooner than would be possible using the traditional government financing approach.' However, of the 4 projects, the 3 larger ones will in all likelihood involve not only construction but also profit-generating facility management, maintenance and services. As for protection against financial risk, in the UK, P3 hospital development has frequently greatly exceeded budgets and timelines. While the public may have title, in the UK, control has been elusive as it has commonly been difficult and expensive to bring about needed structural and service changes. And there is no basis for claiming that P3s achieve development ‘sooner’.
The solution is for hospital redevelopment to be funded publicly. Governments can obtain much more favourable borrowing terms than can the private sector. The public will pay for our hospitals either way. But with public funding, we avoid the higher costs of P3s and keep hospital management, property and services in public hands. And we stop the growth of a for-profit health industry that has an interest in two tier healthcare from which they can take profit, further increasing the cost of health care.
As Roy Romanow, head of the Commission on the Future of Health Care in Canada said in his report: ‘I have carefully explored the experiences of other jurisdictions with co-payment models and with public-private partnerships and have found these lacking. There is no evidence that these solutions will deliver better or cheaper care, or improve access (except, perhaps, for those who can afford to pay for care out of their own pockets). More to the point, the principles on which these solutions rest cannot be reconciled with the values at the heart of medicare or with the tenets of the Canada Health Act that Canadians overwhelmingly support.’
We call on the government to act in the public interest and to use citizens' dollars responsibly. Hospital construction and services must be publicly funded and hospitals must remain fully publicly managed and serviced.
1. Diana R. Ahmed, MD, CCFP, Hamilton
2. Anna Banerji, MD MPH FRCPC DTM&H, Toronto
3. Lopita Banerjee, MD CCFP, Brampton
4. Ahmed Bayoumi, MD, Toronto
5. Gary Bloch, MD, Toronto
6. Wendell Block, MD, Lawrence Heights Community Health Centre, Toronto
7. Ken Burgess, MD, Assistant Clinical Professor, Dept of Family Medicine, McMaster University, Hamilton
8. Patricia Cavanagh, MD, FRCP(C) Clinical Director, Impact, Toronto Western Hospital, University Health Network, Toronto
9. Deborah Cook, MD, Professor of Medicine, Clinical Epidemiology and Biostatistics, Hamilton
10. Debby Copes, MD, Toronto
11. Tyler J. Curtis MD, CCFP, Toronto
12. PJ Devereaux, MD, FRCP(C), Hamilton
13. Mimi Divinsky, MD CCFP, FCFP, Toronto
14. Murray Enkin, MD, Toronto
15. George Freundlich, MD, CCFP, FCFP, Chief of Staff, Medical Director, Bingham Memorial Hospital, Matheson
16. Hugh Fuller, MD, Ancaster
17. Miriam Garfinkle, MD, Toronto
18. Qais Ghanem, MD FRCPC, Ottawa
19. Sanjeev Goel, MD CCFP, Brampton
20. C. Ross Green, MD, CM, Thorndale
21. Gordon Guyatt, MD, Hamilton
22. Ted Haines, MD, Hamilton
23. David R S Haslam, MSc, MD, London
24. Debbie Honickman, MD, Toronto
25. Roman Jaeschke, MD, Hamilton
26. Robert A James, MD, FCFP, Dundas
27. Norman Kalant, MD, PhD, Toronto
28. Atul Kapur, MD, MSc, FRCP(C), Ottawa
29. Nicholas Kates, MD, Hamilton
30. Tara Kiran, MD CCFP, Toronto
31. Haresh Kirpalani, MD, Neonatal Intensive Care, Hamilton
32. Steven Kravcik, MD, FRCPC, Division of General Medicine, Ottawa Hospital, Ottawa
33. Wendy Lai, MD, CCFP, Toronto
34. Margaret Lathwell, MD, CCFP, Toronto
35. Joel Lexchin, MD, Associate Professor, School of Health Policy and Management, York University, Toronto
36. Jim Mackenzie, MD, Sarnia
37. John Marshall, MD, Professor of Surgery, University of Toronto, Toronto
38. Tom Mayberry, MD, Ingersoll
39. Rosemary Meier, MD, Geriatric Psychiatrist, Toronto
40. Melissa Melnitzer, MD, CCFP, Toronto
41. Jamie Meuser, MD, Toronto
42. Dr. D.W. Molloy, Chair, St. Peter's McMaster Centre for Studies on Aging, Hamilton
43. Carles Muntaner, MD, PhD, Toronto
44. Richard Nahas, MD CCFP, Ottawa
45. Vic Neufeld, MD, Hamilton
46. Adam Newman, MD, CCFP, Kingston
47. Nicole Nitti, MD, Parkdale Community Health Centre, Humber River Regional Hospital, Toronto
48. James Orbinski, MD, Research Scientist & Associate Professor DFCM, St. Michael's Hospital, & Munk Centre for International Studies University of Toronto, Toronto
49. Catherine Oliver, MD, CCFP, Toronto
50. Nancy Olivieri, MD, FRCP(C), Professor, Pediatrics and Medicine, University of Toronto, Toronto
51. Mario Ostrowski, MD, Clinical Sciences Division, University of Toronto , Toronto
52. Donald Payne, M.D., F.R.C.P.(C), Psychiatrist, Toronto
53. Rosana Pellizzari, MD, Toronto
54. Richard Pickering, MD, Dundas
55. Ruth Pickering, MD, Dundas
56. Jane Pritchard, MD, Toronto
57. Michael Rachlis, MD, Toronto
58. Meb Rashid, MD, Toronto
59. Cathy Risdon, M.D. CCFP, David Braley and Nancy Gordon Chair in Family Medicine, Associate Professor, Department of Family Medicine, McMaster University, Hamilton
60. Najib Safieddine, MD PGY-4 General Surgery, University of Toronto, Toronto
61. Shelly Sender, MD, Dundas
62. Andrea Stern, MD, York Community Services, Toronto
63. Jim Sugiyama, MD, CCFP, Toronto
64. Itamar E Tamari MD CCFP FCFP, Toronto
65. Warren Teal, MD, Sarnia
66. Karen Trollope Kumar MD, Hamilton
67. Tyrone Turner MD FRCP(C), Toronto
68. Jose Venturelli, MD, Professor Emeritus, McMaster University, Hamilton
69. Miriam Wiebe, MD, CCFP, Toronto
70. Shannon Wires, MD, MSc, Paediatric Resident, McMaster Health Centre, Hamilton
71. Donald Woodside MD, Hamilton
72. Susan Woolhouse, MD, CCFP, Toronto
73. Tanya Liv Zakrison, MD, General Surgery, Toronto
Others
Paul A. Hamel, Ph.D. Faculty of Medicine, University of Toronto, Toronto
Carol Kushner, Health Policy Analyst, Toronto
Bradley MacIntosh MSc, Toronto
Gabriela Luchsinger, Social Worker, St. Peter’s Hospital, Hamilton
Medical Students
Michaela Beder, Hamilton
Caroline Eberdt, Hamilton
Anne Nguyen, Hamilton
Andrew Pinto, Toronto
Vikram C. Ravindran, Hamilton
Nicole Shadbolt, Hamilton