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Chapter Five: Contracting-Out Care: Nursing Homes in Canada

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Navigating Private and Public Healthcare

Abstract

From a neoliberal perspective, governments should steer and not row; competitive markets provide effective, quality services; and individuals should take responsibility for much of their own health. These assumptions provide the basis for privatisation, a process with multiple forms that are often quite complicated and difficult to see. More of the costs of services and more of the labour are shifted to individuals and families, management in public services follows practices imported from the for-profit sector and more services are handed over to the for-profit sector while those that remain public are often managed by for-profit firms. One aspect of this for-profit provision is the contracting out of services, which we examine in nursing homes. As feminist political economists, we assume that politics, economics, discourses and ideas are integrally related. We see that the search for profit profoundly influences how we live, work, talk, reproduce and play. So do the actions of individuals and collectives. We insist that the gendered construction of social relations and the interconnections between paid and unpaid labour are critical to our understanding of how things work.

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References

  • Angus Reid Institute. (2015). Prescription Drug Access and Affordability an Issue for Nearly a Quarter of All Canadian Households. Vancouver: Angus Reid Institute. Available at: http://angusreid.org/prescription-drugs-canada [Accessed 15 Sept. 2018].

  • Armstrong, H. (2001). Social cohesion and privatization in Canadian health care. Canadian Journal of Law and Society, 16(2), pp. 65–81.

    Article  Google Scholar 

  • Armstrong, H., Armstrong, P. and Connelly, M.P. (1997). Introduction: the many forms of privatization. Studies in Political Economy, 53(1), pp. 3–9.

    Article  Google Scholar 

  • Armstrong, P. and Braedley, S. (eds.) (2016). Physical Environments for Long-Term Care. Ottawa: Canadian Centre for Policy Alternatives.

    Google Scholar 

  • Armstrong, P. and Day, T. (eds.) (2016). Exercising Choice in Long-Term Residential Care. Ottawa: Canadian Centre for Policy Alternatives.

    Google Scholar 

  • Armstrong, P. and Day, S. (2017). Wash, Wear, and Care: Clothing and Laundry in Long-Term Residential Care. Montreal and Kingston: McGill-Queen’s University Press.

    Google Scholar 

  • Armstrong, P. and Lowndes, R. (2018a). Creative Teamwork: Developing Rapid, Site-Switching Ethnography. New York: Oxford University Press.

    Google Scholar 

  • Armstrong, P. and Lowndes, R. (2018b). Negotiating Tensions in Long-Term Residential Care: Ideas Worth Sharing. Ottawa: Canadian Centre for Policy Alternatives.

    Google Scholar 

  • Armstrong, P., Armstrong, H. and Scott-Dixon, K. (2008). Critical to Care: The Invisible Women in Health Services. Toronto: University of Toronto Press.

    Google Scholar 

  • Armstrong, P., Armstrong, H., and MacLeod, K.K. (2016). The threats of privatization to security in long-term residential care. Ageing International, 41(1), pp. 99–116.

    Article  Google Scholar 

  • Baines, D. and Armstrong, P. (eds.) (2015). Promising Practices in Long Term Care: Ideas Worth Sharing. Ottawa: Canadian Centre for Policy Alternatives.

    Google Scholar 

  • Berwick, D.M., Nolan, T.W. and Whittington, J. (2008). The triple aim: care, health, and cost. Health Affairs, 27(3), pp. 759–769.

    Article  Google Scholar 

  • CHPI. (2015). The Contracting NHS – Can the NHS Handle the Outsourcing of Clinical Services? London: Centre for Health and the Public Interest. Available at: https://chpi.org.uk/wp-content/uploads/2015/04/CHPI-ContractingNHS-Mar-final.pdf [Accessed 15 Sept. 2018].

  • Coyle, A. (2005). Changing times: flexibilization and the re-organization of work in feminized labour markets. In: L. Pettinger et al. (eds.) A New Sociology of Work? Malden MA: Blackwell. pp. 73–88.

    Article  Google Scholar 

  • CUPE Canadian Union of Public Employees. (2009). Healthcare Associated Infections: A Backgrounder. Ottawa: CUPE Canadian Union of Public Employees. Available at: https://cupe.ca/health-care-associated-infections-backgrounder-and-fact-sheet [Accessed 15 Sept. 2015].

  • CUPE Canadian Union of Public Employees. (2013). Backgrounder on K-Bro Linen Systems: The New Provider of Hospital Linens in Saskatchewan. Ottawa: CUPE Canadian Union of Public Employees. Available at: https://sk.cupe.ca/files/2013/04/Final-K-Bro-Backgrounder-_CUPE_December-17-2013.pdf [Accessed 16 Mar. 2015].

  • Daly, T., Armstrong, P. and Lowndes, R. (2015). Liminality in Ontario’s long-term care facilities: private companions’ care work in the space ‘betwixt and between’. Competition and Change, 19(3), pp. 246–263.

    Article  Google Scholar 

  • Devereaux, P.J., Choi, P.T., Lacchetti, C., Weaver, B., Schünemann, H.J., Haines, T., Lavis, J.N., Grant, B.J., Haslam, D.R., Bhandari, M., Sullivan, T., Cook, D.J., Walter, S.D., Meade, M., Khan, H., Bhatnagar, N. and Guyatt, G.H. (2002a). A systematic review and meta-analysis of studies comparing mortality rates of private for-profit and private not-for-profit hospitals. Canadian Medical Association Journal, 166(11), pp. 1399–1406.

    Google Scholar 

  • Devereaux, P.J., Schünemann, H.J., Ravindran, N., Bhandari, M., Garg, A.X., Choi, P.T., Grant, B.J., Haines, T., Lacchetti, C., Weaver, B., Lavis, J.N., Cook, D.J., Haslam, D.R., Sullivan, T. and Guyatt, G.H. (2002b). Comparison of mortality between private for-profit and private not-for-profit hemodialysis centers: a systematic review and meta-analysis. Journal of the American Medical Association, 188(19), pp. 2449–2457.

    Article  Google Scholar 

  • Devereaux, P.J., Heels- Ansdell, D., Lacchetti, C., Haines, T., Burns, K.E.A., Cook, D.J., Ravindran, N., Walter, S.D., McDonald, H., Stone, S.B., Patel, R., Bhandari, M., Schünemann, H.J., Choi, P.T.L., Bayoumi, A.M., Lavis, J.N., Sullivan, T., Stoddart, G. and Guyatt, G.H. (2004). Payments for care at private for-profit and private not-for-profit hospitals: a systematic review and meta-analysis. Canadian Medical Association Journal, 170(12), pp. 1817–1824.

    Article  Google Scholar 

  • Dickman, S.L., Himmelstein, D.U. and Woolhandler, S. (2017). America: equity and equality in health 1. Inequality and the health care system in the USA. Lancet, 389(10077), pp. 1431–1441.

    Google Scholar 

  • Dryden, R. and Stanford, J. (2012). The Unintended Consequences of Outsourcing Cleaning Work. Ottawa: Canadian Centre for Policy Alternatives. Available at: https://www.policyalternatives.ca/publications/reports/unintended-consequences-outsourcing-cleaning-work [Accessed 15 Sept. 2018].

  • Extendicare REIT. (2007). Extendicare Assist Management and Consulting Services. Available at: http://extendicareassist.ca [Accessed 1 Sept. 2018].

  • Fedorak, J. (2010). Order F10-28: Vancouver Coastal Health Authority. Victoria: Office of the Information and Privacy Commissioner for British Columbia. Available at: https://www.oipc.bc.ca/orders/1061 [Accessed 15 Sept. 2018].

  • Fox, A. and Poirier, R. (2018). How single-payer stacks up: evaluating different models of universal health coverage on cost, access and quality. International Journal of Health Services, 48(3), pp. 568–585.

    Article  Google Scholar 

  • Harrington. C., Woolhandler, S., Mullan, J., Carrillo, H. and Himmelstein, D.U. (2001). Does investor ownership of nursing homes compromise the quality of care? American Journal of Public Health, 91(9), pp. 1–5.

    Article  Google Scholar 

  • Harrington, C., Jacobsen, F.F., Panos, J., Pollock, A., Sutaria, S. and Szebehely, M. (2017). Marketization of long-term care: a cross-country comparison of large for-profit nursing home chains. Health Services Insights, 10, pp. 1–23.

    Article  Google Scholar 

  • Hodge, G. (2000). Privatization: An International Review of Performance. Boulder, CO: Westview Press.

    Google Scholar 

  • Lowndes, R. and Müller, B. (2015/2016). Germany: Small Town 1. In: D. Baines and P. Armstrong (eds.) Promising Practices in Long Term Care: Ideas Worth Sharing. Ottawa: Canadian Centre on Policy Alternatives. pp. 47–50.

    Google Scholar 

  • McGregor, M., Cohen, M., Stocks-Rankin, C.A., Cox, M.B, Salomons, K., McGrail, K.M., Spencer, C., Ronald, L.A. and Schulzer, M. (2011). Complaints in for-profit, non-profit and public nursing homes in two Canadian provinces. Open Medicine, 5(4), pp. e183–e192.

    Google Scholar 

  • McGregor, M., Abu-Laban, R.B., Ronald, L.A., McGrail, K.M., Andrusiek, D., Baumbusch, J., Cox, M.B., Salomons. K., Schulzer, M., and Kuramoto, L. (2014). Nursing home characteristics associated with resident transfers to emergency departments. Canadian Journal on Ageing, 33(1), pp. 38–48.

    Article  Google Scholar 

  • McGregor, M. and Ronald, L.A. (2011). Residential Long-Term Care for Canadian Seniors: Non-profit, For-profit or Does It Matter? Montreal: Institute for Research on Public Policy. Available at: http://irpp.org/research-studies/residential-long-term-care-for-canadas-seniors/ [Accessed 15 Sept. 2018].

  • Mol, A. (2008). The Logic of Care: Health and the Problem of Patient Choice. London: Routledge.

    Google Scholar 

  • Munford, R. and Sanders, J. (2001). The buck stops where? Contracting, service delivery and the challenge to provide responsive services. Social Work in Health Care, 34(1/2), pp. 43–57.

    Article  Google Scholar 

  • Rau, J. (2018). Care suffers as more nursing homes feed money into corporate webs. New York Times. Available at: https://www.nytimes.com/2018/01/02/business/nursing-homes-care-corporate.html [Accessed 15 Sept. 2018].

  • Rice, T. (1997). Can markets give us the health system we want? Journal of Health Politics, Policy and Law, 22(2), pp. 383–426.

    Article  Google Scholar 

  • Ronald, L., McGregor, M., Harrington, C., Pollock, A. and Lexchin, J. (2016). Observational evidence of for-profit delivery and inferior nursing home care: when is there enough evidence for policy change? PLoS Medicine, 13(4), pp. 1–12.

    Article  Google Scholar 

  • Stein, J.G. (2001). The Cult of Efficiency. Toronto: Anansi.

    Google Scholar 

  • Tanuseputro, P., Chalifoux, M., Bennett, C., Gruneir, A., Bronskill, S., Walker, P. and Manuel, D. (2015). Hospitalization and mortality rates in long-term care facilities: does for-profit status matter? Journal of the American Medical Directors Association, 16(10), pp. 874–883.

    Article  Google Scholar 

  • Vrangbæk, K., Petersen, O. and Hjelmar, U. (2013). Is contracting-out good or bad for employees? A review of international experience. Review of Public Personnel Administration, 35(1), pp. 3–23.

    Article  Google Scholar 

  • Woolhandler, S., Campbell, T. and Himmelstein, D.U. (2003). Costs of health care administration in the United States and Canada. New England Journal of Medicine, 349(8), pp. 768–775.

    Article  Google Scholar 

  • Woolhandler, S. and Himmelstein, D.U. (2004). The high costs of for-profit care. Canadian Medical Association Journal, 170(12), pp. 1814–1815.

    Article  Google Scholar 

  • Zuberi, D. and Ptashnick, M.B. (2011). The deleterious consequences of privatization and outsourcing for hospital support work. Social Science and Medicine, 72(6), pp. 907–911.

    Google Scholar 

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Acknowledgements

Work on this chapter has been supported by ‘Re-Imagining Long-Term Residential Care: An International Study of Promising Practices’ (Pat Armstrong, Principal Investigator) funded by the Social Sciences and Humanities Research Council of Canada, grant # 412-2012-1004.

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Armstrong, P., Armstrong, H. (2020). Chapter Five: Contracting-Out Care: Nursing Homes in Canada. In: Collyer, F., Willis, K. (eds) Navigating Private and Public Healthcare. Palgrave Macmillan, Singapore. https://doi.org/10.1007/978-981-32-9208-6_5

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  • DOI: https://doi.org/10.1007/978-981-32-9208-6_5

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