Financial Post: Lose money selling coffee and doughnuts to Canadians? Some hospitals do.

Back in 2012, the National Post published an eye-popping headline: “Tim Hortons with $26/hour servers putting Windsor hospital $265K in the hole.” The same story noted that a government-run Tim Hortons at a hospital in Newfoundland and Labrador had also lost over $260,000 the year before. That’s right. They lost money. Selling coffee and doughnuts to Canadians.

SecondStreet.org recently decided to investigate hospital cafeteria losses right across the country and to do a followup on the aforementioned government-run Tim Hortons that made such an unlikely splash.

In the grand scheme of health-care spending, of course, this issue is pretty small. It’s still important, though. When hospitals lose money selling double-doubles, doughnuts and soft drinks, those are dollars that can’t be spent on providing services to patients. And there may be similar losses, maybe even larger ones, when they stray into other areas outside their core competencies.

When it comes to health care, all dollars matter. For instance, Alberta patient Jackie Herrera was told she would have to wait a year just to see a neurologist. So, while she was living with extreme pain and discomfort, her government lost millions covering losses at hospital cafeterias. Had some of those dollars been put towards providing care to patients, maybe Jackie wouldn’t have done what she eventually had to do — travel to Germany and pay for treatment out of her own pocket.

When COVID-19 emerged in Canada, governments across the country postponed thousands of surgeries, diagnostic scans and appointments with specialists. Already lengthy waiting lists grew even longer. In order to shorten those backlogs, governments will need to look under every stone to find savings. Ancillary services are a big, bleeding stone.

After filing over 120 freedom-of-information requests with health authorities across Canada, SecondStreet.org found dozens of facilities that lost money — more than $12 million in losses over a two-year period. Keep in mind this figure does not include data from Quebec or from several other health authorities elsewhere in Canada that provided incomplete information. For perspective, $12 million is roughly equivalent to the cost of providing MRI scans to an NHL arena full of people.

SecondStreet.org discovered that the Newfoundland and Labrador hospital that previously lost money through its Tim Hortons has since gotten out of the double-double game. Now a private firm runs the outlet and the losses have stopped.

In Ontario, as well, some progress has been made at the Windsor Regional Hospital. The facility went from three to two Tim Hortons kiosks; one earned $111,508 during the two-year period we examined while the other lost $74,775 — which begs the question: why not cut your losses and shut down the one that’s losing money?

SecondStreet.org also discovered a third hospital in Canada that has been running a money-losing Tim Hortons. This one is at the Saint John Regional hospital in New Brunswick and it lost $278,734 from 2017-19.

Whether we’re talking about a government-run Tim Hortons or a regular hospital cafeteria the losses are likely due to the overly generous wage structure in government.

As the CEO of Eastern Health in Newfoundland and Labrador explained back in 2012: “… we charge you $1.94 for that large coffee, but we insist that the staff who are pouring that coffee are Eastern Health staff, and they get paid $28 an hour, and no Tim Hortons pays that.”

A second reason why governments often lose money through their hospital cafeterias comes down to core competencies. Simply put, governments are involved in countless services. They cannot devote the time and energy needed to be experts in each area.

The Victoria General Hospital in Winnipeg lost $186,851 at its cafeteria in 2011-12. After renting the space out to a private restaurant, however, it earned $25,591 the following year in rent. Ultimately, that meant more funds could be spent helping patients.

As governments seek to address their waiting-list backlogs, SecondStreet.org’s findings are clear: addressing cafeteria losses could take at least a small bite out of the problem.

 

Colin Craig is president of SecondStreet.org, a new Canadian think-tank.

This column was published by Financial Post on Nov 4th, 2020.

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Prevention – reduce demand in the first place

If Canadians lived healthier lives, we could reduce demand for emergency services, orthopaedic surgeries, primary care and more. 

For instance, if you visit the Canadian Cancer Society’s website, you’ll read that “about four in ten” cancer cases are preventable. The Heart and Stroke Foundation notes that “almost 80 percent of premature heart disease and stroke can be prevented through healthy behaviours.” A similar number of Diabetes cases are also preventable. 

Many joint replacements and visits to ERs and walk-in clinics could also be avoided through healthy living. 

To be sure, not all health problems can be avoided through healthy living – everyday the system treats Canadians with genetic conditions, helps those injured in unavoidable accidents and more.  

But there is an opportunity to reduce pressure on the health care system through Canadians shifting to healthier lifestyles – better diets, more exercise, etc. 

To learn more, watch our Health Reform Now documentary (scroll up) or see this column. 

Partner with non-profits and for-profit clinics

European countries will partner with anyone who can help patients. 

It doesn’t matter if it’s a non-profit, a government entity or a private clinic. What matters is that patients receive quality treatment, in a timely manner and for a competitive price.  

In Canada, governments often delivery services using government-run hospitals instead of seeing if non-profit or private clinics could deliver the services more effectively. 

When governments have partnered with non-profit and private clinics, the results have often been quite good – Saskatchewan, Ontario and British Columbia are just a few examples of where partnerships have worked well. 

Canada should pursue more of these partnerships to reduce wait times and increase the volume of services provided to patients.  

To learn more, watch our Health Reform Now documentary (scroll up) or see the links above. 

Make cross border care more accessible

In Canada, citizens pay high taxes each year and we’re promised universal health care services in return. The problem is, wait times are often extremely long in our health system – sometimes patients have to wait years to see a specialist or receive surgery. 

If patients don’t want to wait long periods, they often have to reach into their own pocket and pay for treatment outside the province or country. 

Throughout the European Union, we also find universal health care systems. But a key difference is that EU patients have the right to go to other EU countries, pay for surgery and then be reimbursed by their home government. Reimbursements cover up to what the patient’s home government would have spent to provide the treatment locally. 

If Canada copied this approach, a patient waiting a year to get their hip operation could instead receive treatment next week in one of thousands of surgical clinics throughout the developed world. 

Governments benefit too as the patient is now back on their feet and avoiding complications that sometimes come with long wait times – meaning the government doesn’t have to treat those complications on top of the initial health problem. 

To learn more, watch our Health Reform Now documentary (scroll up) or this shorter video. 

Legalize access to non-government providers

Canada is the only country in the world that puts up barriers, or outright bans patients from paying for health services locally. 

For instance, a patient in Toronto cannot pay for a hip operation at a private clinic in Toronto. Their only option is to wait for the government to eventually provide treatment or leave the province and pay elsewhere. 

Countries with better-performing universal health care systems do not have such bans. They allow patients a choice – use the public system or pay privately for treatment. Sweden, France, Australia and more – they all allow choice. 

Why? One reason is that allowing choice means some patients will decide to pay privately. This takes pressure off the public system. For instance, in Sweden, 87% of patients use the public system, but 13% purchase private health insurance. 

Ultimately, more choice improves access for patients. 

To learn more, watch our Health Reform Now documentary (scroll up) or watch this short clip on this topic. 

Shift to funding services for patients, not bureaucracies

In Canada, most hospitals receive a cheque from the government each year and are then asked to do their best to help patients. This approach is known as “block funding”. 

Under this model, a patient walking in the door represents a drain on the hospital’s budget. Over the course of a year, hospital administrators have to make sure the budget stretches out so services are rationed. This is why you might have to wait until next year or the year after for a hip operation, knee operation, etc. 

In better-performing universal health systems, they take the opposite approach – hospitals receive money from the government each time they help a patient. If a hospital completes a knee operation, it might receive, say, $10,000. If it completes a knee operation on another patient, it receives another $10,000. 

This model incentivizes hospitals to help more patients – to help more patients with knee operations, cataract surgery, etc. This approach also incentivizes hospitals to spend money on expenses that help patients (e.g. more doctors, nurses, equipment, etc.) rather than using the money on expenses that don’t help patients (e.g. more admin staff). 

To learn more about this policy option, please watch our Health Reform Now documentary (scroll up) or see this post by MEI.