First Comprehensive Overview of Increasing Privatization of Ontario's Health Care System Paints Disturbing Picture -- Changes and Cuts Put Women At Risk: York U. Report

TORONTO, December 3, 1999 -- The increasing shift of health care dollars and health care services from public to private is jeopardizing women's health and threatening the jobs of female health-care practitioners, according to a report released today by the National Network on Environments and Women's Health at York University (NNEWH).

The report, Women, Privatization and Health Care Reform: The Ontario Case, is the first comprehensive scan of the effects of privatization and health care reform on women as patients, providers and decision-makers.

Co-authored by network partner and York University Sociology Prof. Pat Armstrong and Carleton University School of Social Work Prof. Hugh Armstrong, the report also shows that Ontarians paid more out of their own pockets for health care than any other Canadian in 1998. Ontario's per-capita health care expenditures dropped from 72.9 per cent in 1990 to 66.9 per cent in 1998, ranking it last in the country. Even Alberta spent more -- 69.4 per cent -- challenging the conventional wisdom that Alberta is the country's poster province for health care privatization.

"Ontario has privatized health care more extensively and more rapidly than any other province. The shift from a public health care system to one which is increasingly for-profit has occurred with little or no hard evidence of any benefits, ignoring the consequences -- especially for women's health and female care-givers -- and providing no monitoring or measuring of the effects of the shift in terms of the impact on women," said Prof. Pat Armstrong.

Among the report's findings:

The transformation of chronic care hospitals into long-term care facilities means patients requiring 24-hour-a-day care will be in facilities with almost no Registered Nurses. At the Perley-Rideau Veteran's Health Centre in Ottawa, for example, staff nurses saw their workload double from a ratio of one nurse for every 20 patients to one to 40, and it will rise to one to 80 in the year 2000. The transformation also means patients are in facilities that are no longer protected under the Canada Health Act, which means the province is free to charge fees on at least part of the care. The province can also hand over the entire operation to a for-profit company.

One-third of Ontario's chronic care patients are restrained daily, typically by being tied to wheelchairs or placed in chairs so deep that they cannot climb out. Ontario's rate is double that of the United States.

The number of Registered Nurses and Registered Practical Nurses employed in Ontario hospitals declined from 74,007 in 1991 to 60,446 in 1998. The number employed on a casual basis increased by 4,778 during this period while the number employed full-time declined by 9,000. Many of those with casual employment work in for-profit firms providing community services.

The loss of jobs in the hospital sector also often means a loss of pay and benefits, even for full-time employees. Hourly rates for RNs providing home nursing services range from approximately $16 to $23, versus a range of approximately $19 to $28 per hour in hospital settings.

Long-term care facilities now have to deal with a patient population of whom 60 per cent require heavy care, estimated to be 3.5 hours per day or more -- this before the transfer of patients forced out of chronic care and acute care hospitals. Most of this population is female.

Long-term care providers are not being trained for the new demands, especially those resulting from the transfer of difficult psychiatric cases from mental health facilities. Violence towards other residents and providers is on the rise; those interviewed felt they had neither the skills nor the support to handle this escalation. Increasingly, the new staff has come out of workfare programs, often with minimal training. Because they have not freely chosen the job, the workfare women frequently find it difficult to cope, especially under the increasingly stressful conditions.

It is difficult to determine how many of the 7,371 hospital beds that disappeared between 1995 and 1998 were lost to women, although in 1991 women were much more likely than men to be in hospitals and to stay longer. It is clear to see, however, the effects of hospital restructuring on women when they are shipped around the province in search of neo-natal beds or are sent to the United States for breast cancer treatments.

In doctors' offices, a maximum of two Pap smears are covered each year; pregnant women can have only one ultrasound covered by OHIP. If they need more, it will cost women $30 for a Pap smear or $128 for an ultrasound.

Private home-care companies entering the market can deliberately drive down the cost per visit in order to squeeze out as many players as possible, at which point they will be in a position to raise the price per visit.

Two-thirds of home care recipients are women. In 1994-95, more than half of those who needed help with personal care received no formal care; the percentage was even greater for those who needed help with the everyday living activities. To be eligible for public services, according to 1998 provincial government guidelines, people must have first exhausted the care giving and support capacities of their friends, relatives and other community members. Women are the most likely to be classified as capable care givers.

Prof. Hugh Armstrong said many of the prevailing trends in health care restructuring and privatization are having a demonstrated negative effect on women's lives. "Women's choices about care are increasingly restricted, especially for the frail elderly, those with disabilities, and the many poor women without the resources to purchase or successfully demand appropriate care. Female care providers face an equally bleak situation. They are being replaced by lesser skilled, non-unionized workers, stripped of job security, benefits and adequate pay. All of these factors add up to a very dismal picture of our health system," he said.

Pat Armstrong is co-author of such books as Wasting Away: The Undermining of Canadian Health Care; Universal Health Care: What the United States Can Learn From Canada; Vital Signs: Nursing in Transition; and Take Care: Warning Signals for Canada's Health System. She has also published on a wide variety of issues related to women's work and to social policy. She has served as Chair of the Department of Sociology at York University and Director of the School of Canadian Studies at Carleton University. She is a partner in the National Network on Environments and Women's Health, and is currently chairing a working group on health reform that crosses the Centres of Excellence for Women's Health.

Hugh Armstrong is a Professor in the School of Social Work and the Institute of Political Economy at Carleton University in Ottawa. With Dr. Pat Armstrong, he has written extensively on health care and on women and work. He currently serves as an elected member of the Board of Directors for the Ottawa-Carleton Community Care Access Centre (CCAC), and as co-ordinator of the editorial board for the academic journal Studies in Political Economy.

The National Network on Environments and Women's Health (NNEWH) at York University is one of five federally funded regional Centres of Excellence for women's health that will receive research funding from 1996-2002. The goal of the Centres of Excellence for Women's Health Program is to carry out research in collaboration with community agencies.

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For more information or a copy of the study, please contact:

Prof. Pat Armstrong
Department of Sociology
York University
(416) 736-2100, ext. 55015
patarmst@yorku.ca

Prof. Hugh Armstrong
School of Social Work
Carleton University
(613) 520-2600, ext. 1890
hugh_armstrong@carleton.ca

Ken Turriff
Media Relations
York University
(416) 736-2100, ext. 22086
kturriff@yorku.ca
YU/137/99