Shouldice Hospital 

Shouldice Hospital

I turned 50 this month, and went in for hernia surgery.

Living in southern Ontario, it was recommended that I go to Shouldice Hospital, which does only hernia surgery. Of the three or so techniques available, Shouldice does only one (except when they have tested the others), and they do it on a large scale, with great efficiency. They attract patients from all over the world. They now seem indispensable in this area, but they are controversial in the context of Medicare and single-payer public health insurance.

Jack Layton, leader of the federal New Democratic Party, was forced to admit in the recent federal campaign that he had surgery at Shouldice, a private hospital, despite the fact that he presents himself as a defender of a public-only system. His defence was that the hospital took OHIP for the procedure itself (true), his referral there was totally seamless, and he literally didn't even know it was private. The clincher: it's a "non-profit" hospital.

Well: I'm not sure anyone outside the hospital knows everything about their finances. They are apparently allowed to pay dividends to two owners--the surviving son and daughter of the original Dr. Shouldice--and then they are required to pay the remaining profit to the Ontario government. Hence: net non-profit.

But: one report says there is profit-sharing with staff. Does this come out of the dividends paid to the owners? Does the dividend increase with better performance, cutting costs while maintaining quality, for example, so that there is money to share with staff?

The hospital is non-profit, however exactly that is calculated, but the "clinic" is a for-profit. Where is the line drawn? The examinations are in the clinic, paid by OHIP? Lab work?

The only rooms available are semi-private, which are not covered by OHIP in Ontario. People on welfare cannot benefit from Shouldice. On the other hand, one of my fellow patients had information that our public hospitals now charge $500 or more for a semi-private room; Shouldice is a bargain for patients or insurers at $110 or $120. (I have extended health which pays for a semi-private room).

Shouldice confine themselves to patients who are "otherwise healthy"--able to walk in to an examination, etc. They will famously tell people to lose weight and get more fit before surgery.

They have learned to cut down the time on the operating table, and the recovery time. You find yourself in a supportive community--you stay the afternoon and night before surgery, getting a chance to talk to people who are a day or two ahead of you in the process--proably shuffling around. Then you have the tough surgical day, when you are encouraged to do at least some walking after four hours of rest. Day 3, the day after surgery, half of the external clips or stitches come out; Day 4, the other half. You are usually encouraged to stay one more night, and leave on Day 5. I left on Day 4.

They are very good at what they do. Why can't they become a model for other specific surgeries that could then be taken out of our overburdened public hospitals? Certain orthopedic procedures, for example?

The unions don't like Shouldice, and they emphasize the cherry-picking of healthy patients--which helps reinforce the impression private sector good and efficient, public sector bad and inefficient.

At least some questions arise that would arise with any model of private care within an overall public system. If doctors and nurses are given a chance to work exclusively in such a pleasant environment, with healthy patients, will they take it, and leave the already worse-off patients in a ghetto of inferior care? Is it true that the public sector can build an all-public institution like Shouldice? Can all the proper incentives be created? If so, why has it not been done?

I was very pleased with my care. You definitely feel that you have a nasty incision, but also that the people around you know how you can get back into your routine as quickly as possible.

For more reading: See also here. Also good old Wikipedia: it may not be easy to compare results at different hospitals.

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