For
the past 30 years, the provincial government has paid for and managed ambulance
services in Ontario. It is a public, non-profit system that gives everybody
equal access to emergency medical help when they need it, no matter where they
live in Ontario and no matter what their income level.
Ambulances
are staffed by trained medical professionals who can get you to the
hospital alive. Ambulance paramedics can re-start your heart using the
same procedures and medications as a hospital emergency room. They can
administer drugs, stop the bleeding, control seizures and reverse the
effects of an allergic reaction or a diabetic attack.
Currently, land ambulance services
are provided in three ways: by the Ministry of Health, by hospitals,
or by private operators. The Ontario government, it is estimated,
spends about $200 million funding land ambulance. All of the
services have their budgets approved by the province. The province
then funds them, on a line-by-line basis. This means the private
operators do not act as true private entrepreneurs. They do not make
a profit. Instead, the province pays them a management compensation
package for running the service. The 47 private operators who employ
paramedics represented by OPSEU are considered "crown agents
for the purposes of collective bargaining."
Downloading opens
the door to privatization
Ontario’s land ambulance services
are in trouble. In January 1997, the Mike Harris government
announced the downloading of ambulance services to what are known as
Upper-Tier Municipalities (UTMs) in government-speak. The 36 UTMs in
Ontario are either regional governments (as in the Regional
Municipality of Ottawa-Carleton), or county governments (as in the
County of Middlesex).
Since 1997, the downloading has
unfolded as a step-by-step process. On Jan. 1, 1998, UTMs became
responsible for paying 100 per cent of the cost of ambulance. This
meant ambulance services would be paid for out of property taxes, a
policy direction opposed by many. David Crombie’s Who Does What
Advisory Panel had advised the exact opposite: "The province
should continue to fund and control ambulance services as part of
the health care system".
In reality, the system carried on as
before, but the province was billing back the municipalities for the
cost. But in the run-up to the recent provincial election, the
Conservative government relented somewhat on the funding issue. On
March 23, the province announced it would pay half the cost of land
ambulance, retroactive to Jan. 1 of this year.
The Tories also gave UTMs an extra
year to take over responsibility for ambulance services, from Jan.
1, 2000 to Jan. 1, 2001. Before that date, UTMs have to choose one
of three options:
- Directly operate the service
themselves;
- Contract out ambulance service
through a Request for Proposal process;
- Negotiate with the existing
providers to continue providing the service.
Municipalities
start to make up their minds
If UTMs want to take over ambulance
by Jan. 1, 2000, they have to inform the province about the option
they have chosen by Sept. 30th. Many of the larger UTMs
have started to make up their minds. Durham and York Regions in the
Greater Toronto Area have each decided to directly operate a
consolidated land ambulance service.
Peel Region, also in the GTA, and
Niagara Region have each chosen to issue a Request for Proposal
(RFP). One of the proposals Niagara will be reviewing comes from the
region itself. Niagara has hired consultants to prepare a proposal
about the region directly operating the service.
Although it has issued an RFP, Peel
will wait until Jan. 1, 2001 before it takes over responsibility for
ambulance. This means the status quo will remain in effect until
then. Halton Region in the GTA, has decided to negotiate with the
existing operators to continue running the service.
Privatization: the
U.S. experience
Since the initial downloading
announcement in 1997, ambulance paramedics across the province have
been lobbying their provincial and municipal politicians. Mostly,
they are lobbying against the contracting-out option. If
cash-strapped UTMs decide to privatize, paramedics know that the
private, for profit ambulance companies will be at the door, looking
to expand in Ontario.
Paramedics believe the privatization
of ambulance services will lead to a reduction in the quality of
service. They point out that typically, private enterprise demands a
15 per cent profit margin. As private ambulance firms demand their
profits, only two things can happen: service will be reduced, or
municipalities will be forced to pay more.
This has been the experience of
several communities in the U.S. The Hartford Courant, a
Connecticut newspaper, published an article on American Medical
Response (AMR) on Jan. 18. AMR, a subsidiary of the Canadian
company, Laidlaw Inc, is a conglomerate of about 200 ambulance
firms.
According to the article, AMR was
successful in getting 59 seconds added to the eight-minute response
time required under its contract with Oklahoma City. The Hartford
Courant reports that in Newington, Connecticut, AMR is lobbying
to lower the percentage of life-threatening emergencies to which it
must respond within eight minutes. AMR is also asking that the town
pay a bonus each time an ambulance arrives on the scene earlier than
expected.
The Hartford Courant
quotes a former AMR executive as saying: "There’s an inherent
conflict between trying to answer the profit-driven concerns of
shareholders and doing a good job out on the street."
(Under copyright law, we cannot
reprint the Jan. 18th article entitled: "Firm Puts
Squeeze on 911 Service In Drive For Profits, AMR Whittles Ambulance
Standards" from The Hartford Courant. However, you can
access the newspaper’s archives at: www.courant.com/news/library.
For more information on the American
experience with private, for-profit ambulance services, please visit
the website of the Department of Health and Human Services and look
under ambulance: www.dhhs.gov/progorg/oei/reportindex.html
Save the service
that could save your life
Emergency health care is a vital part
of Ontario’s health care system. There is every indication that
the need for ambulances will increase. With an aging population, the
number of ambulance calls is already rising sharply. The IBI
Group’s Land Ambulance Service Review for Durham, York and Halton
Regions reports that calls will increase by at least 32 per cent
over the next five years. And with Ontario’s 35 hospitals closing,
ambulances have farther to go to find an emergency room.
Ambulance paramedics need your help.
Please attend the council meetings of your regional and/or county
governments. Find out where they stand on ambulance privatization.
Help save the service that could save your life.
OPSEU represents about 1,600
paramedics in 10 Ministry of Health Services, 47 crown agent
services and 10 hospital services.
