WINDSOR STAR COLUMN: Time for hospital’s coffee sale losses to be curtailed

Tim Horton's Mug

For the average Canadian, it might be difficult to imagine how a Tim Horton’s could lose money.

The coffee and doughnut chain is extremely successful nationwide with lineups often stretching out the door.

So, how do you take such a profitable business and make it lose money?

Easy. Let the public sector run it.

At Windsor Regional Hospital, you’ll find a Tim Horton’s at its Met Campus and Ouellette Campus. They are similar to other Tim Horton’s, but there’s a key exception: it’s run by a government-backed entity. And the results haven’t been pretty.

In 2012, Windsor Star broke the story how the hospital’s cafeteria operations, including Tim Horton’s, had lost around $265,000 that year.

That story contributed to SecondStreet.org’s decision to look into hospital cafeteria losses nationwide.

Data obtained through Freedom of Information requests shows that the Windsor hospital’s Tim Horton’s has lost money nearly every year, reaching $2 million in losses overall over the past decade as of 2021-22.

Incredibly, for most of the past decade, the hospital’s Tim Horton’s hasn’t even factored in the free cost of rent and utilities, making the losses even more stunning.

To be sure, $2 million in losses is not a lot of money compared to the hospital’s annual budget, but these dollars could have eased suffering for a fair number of patients.

According to the Canadian Institute for Health Information, the average knee replacement in Ontario costs about $11,500. If the Windsor hospital had not lost money selling coffee to the public, it could have paid for close to 200 knee replacements.

So, what could be leading to all this red ink?

Labour costs appear to be a large part of the problem. When the story broke in 2012, it was reported that servers at the Met campus Tim’s were paid about $26/hour in salary and benefits. At the time, privately-run Tim Horton’s in the province would have paid staff about half that amount.

Since that time, the hospital has refused to release more up-to-date wage information.

The hospital’s CEO, David Musyj, claims that he needs to continue to run a money-losing doughnut shop as shutting it down would break a union agreement. The hospital was able to contract out its cafeteria to the private sector in exchange for agreeing to having unionized hospital staff handle operating their two Tim Horton’s.

However, the losses have continued on for over a decade.

How long must the hospital continue to take money away from patients’ services to pay added funds for running a doughnut shop?

The second argument the hospital’s CEO made for keeping the doughnut shop open was that staff liked it and it kept them close to the hospital.

It seems hard to imagine the hospital’s nurses and doctors irresponsibly bolting for coffee and doughnuts at Tim Horton’s shops around the city while leaving patients high and dry — but there’s an easy solution to that potential problem.

The answer can actually be found in a 2020 letter to the editor by Musyj himself about his money-losing Tim Horton’s. In it, he notes that his hospital was able to earn some revenue by renting out other food service space to private businesses.

Musyj could turn his Tim Hortons franchise over to a business or private sector to run or rent the space out to some kind of other restaurant that staff and visitors perhaps like.

This way, instead of losing money through selling doughnuts and coffee, the space could provide some added revenues for the hospital.

Hopefully for patients, the hospital doesn’t double-double down on continuing to lose money through running its money-losing Tim Horton’s.

More than a decade of losses speak for themselves.

Dom Lucyk is the communications director for SecondStreet.org.

This column was originally published in The Windsor Star on February 25, 2023.

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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.