It is a world-class, for-profit Ontario hospital. Could Shouldice be a model for private health care?
When Ontario Premier Doug Ford recently pondered potential reforms to the provincial health care system, he cited the Shouldice Hospital as an example of the positive role privatization could play.
His praise for the world-renowned private hernia clinic, one of the few hospitals in Ontario allowed to operate for profit, also raised questions as to whether it is a model that could be replicated or lead to the erosion of Medicare and the creation of a two-tier system.
The hospital, in Thornhill, just north of Toronto, sits on 20 acres of country estate, with gardens and walking paths – making it more like a spa – 89 licensed beds and five operating theatres. The menu includes starters such as Rainbow Trout with Hollandaise Sauce, Roasted Potatoes and Green Beans or Coconut Chicken Curry with Singapore Noodles.
A former patient recently joked on Facebook that he was still 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 a year.
This means, according to the hospital, that its surgeons repair more hernias in a year than most in their lifetime.
“Our surgeons and surgical team are second to none,” John Hughes, CEO of Shouldice Hospital, said in an email to CBC News. “Since our surgeons only do hernia repairs…they are just excellent at what they do – the more you do, the better you get.”
Shouldice also says its model allows it to operate at a lower cost per case than public hospitals and wait times are a fraction of those in the public system.
The hospital also claims that its infection, complication and recurrence rate is less than 0.5% for primary inguinal hernia repairs, the lowest recorded in the world.
The surgeries themselves are covered by OHIP.
Apart from that “we charge a semi-private room at a rate in line with the rest of [Toronto-area] hospitals,” Hughes said. “There is no additional billing for other services, for example medical, food, medication.
But due to the hospital’s policy that most patients must stay at least three days or more after surgery, these room charges generate significant revenue, critics say.
“A lot of people who go there, go there because they have very good private insurance,” Ontario MP France Gélinas, NDP health critic, said in a statement.
Founded in 1945
The hospital was founded in 1945 by Dr. Edward Earle Shouldice, who performed hernia surgeries for servicemen during World War II, according to his grandson Daryl Urquhart.
“To When the war ended, there was this line of people eager and eager to have their hernia repaired. And there was a shortage of beds in hospitals. And so my grandfather decided the best way to handle this was to open a hospital,” said Urquhart, who is also a former co-owner and former director of business development for Shouldice.
Its first location was in downtown Toronto, but as it became more popular it moved to Thornhill, in the estate of George McCullagh, a millionaire miner and newspaper publisher, who bought the Globe newspaper and the Mail and Empire, merging them to create the Globe and Mail.
The main residence of the estate has been transformed into a hospital. In 1971, the province’s Private Hospitals Act was amended to prohibit any new private hospitals, but those already in operation were grandfathered. There are only three private, for-profit hospitals left in Ontario, and one is Shouldice.
His patients include high-profile politicians and personalities, 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 had been a patient there in the mid-1990s. (Layton said he didn’t know it was a private hospital.)
Urquhart says Shouldice’s specialization model has produced an efficiency and skill set not available anywhere else.
“You just can’t achieve higher levels of efficiency in a general plant than you can achieve in a targeted plant,” he said.
The model can be reproduced
He says the model could be replicated, but would require a focused initiative from specialist healthcare professionals.
“It has to be a concerted effort between professionals, administrators and bureaucrats. And this kind of action usually happens in the private sector, not in the public sector,” he said.
But Dr Hasan Sheikh, vice president of Canadian Doctors For Medicare, said there are “wonderful examples” of not-for-profit surgical centers performing high-volume surgeries for specific conditions.
“And without that profit motive, they’re able to provide extremely efficient, high-quality care,” he said, citing Toronto’s Kensington Institute, which specializes in eye surgery, as a “great example.” .
“It’s comforting to send people to a place that does one and only one thing. And I think, you know, there’s no reason for that to happen in a delivery model at profit.”
The stay of patients questioned
Sheikh also wonders if hernia patients really need to stay in Shouldice for a few days after surgery.
“One of my big concerns is the fact that for a hernia repair – which is a fairly simple operation and in most public hospitals it is a day procedure – in Shouldice these patients stay for three nights.
“Keeping people around longer to do the same procedure doesn’t strike me as particularly innovative,” he said. “And I think when you have that profit motive…it begs the question of whether those decisions are made based on what’s best for patients.”
NDP health critic Gélinas says thousands of hernia surgeries are performed in hospitals across the province by hundreds of general surgeons.
“And everyone is recovering and everyone is satisfied.”
Gélinas also says that with only a limited number of general surgeons in the system, the more doctors who go to private clinics, the fewer there are “available for the rest of us.”
“Private for-profit clinics will cost us all,” she said. “It is deeply disturbing that Mr. Ford mentioned Shouldice as a role model to look up to.”
However, Urquhart defends the hospital’s three-day policy, saying it reduces patient anxiety and leads to fewer potential complications.
“You’ll have people saying, ‘They don’t need to stay. Shouldice just needs to make money and so on.’ And that’s not true. If Shouldice sent patients home the same day or the next day, they would just be putting more patients through the system.
“It makes no difference. The most important thing about the model has always been what’s best for the patient.”