RELEASE & BRIEFING NOTE: The Privatization of COVID-19 Testing in Ontario

Posted: March 30, 2022

(March 30, 2022)

Click here for printable version of release

Click here for printable version of briefing note

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Health Coalition Demands the Ford Government Stop 2–Tier Privatization of COVID–Testing
& Restore Access to Public Testing Urgently as the Pandemic’s 6th Wave Gains Amplitude

Toronto – Step by step, the Ford government has been privatizing PCR testing for COVID during the pandemic, reported the Ontario Health Coalition today in a virtual press conference. Now, a new briefing note released by the Coalition reveals that the government has strictly limited public testing, forcing Ontarians to go to private for-profit chain companies and clinics or go without tests and spread the virus. At the same time, Ford is turning a blind eye to  for-profit clinics charging patients for medically necessary tests. This is a violation of the core tenets of the Canada Health Act, which prohibits user fees for patients for medically needed services. It is also disastrous public health policy, forcing people to pay exorbitant charges, usually amounting to more than $200 per test or go without, the Coalition warned.

Key Findings:

On December 30, 2021, the Ontario government severely restricted access to PCR testing for COVID while the province was in a surge of the Omicron variant. (Omicron BA.1) Since then, only those on a provincially-mandated short list of high-risk people or those working in high-risk settings are eligible for PCR testing. Even people with symptoms and those who have been exposed to the virus — unless they fall within the narrowly drawn eligibility criteria– are not able to access public PCR tests. This means that people cannot get publicly-delivered COVID testing through their local public hospital assessment centre or their local public health unit, even if, for eg., they have GI symptoms and may have Omicron 2 (Omicron BA.2) but cannot be sure whether it is a norovirus or Omicron, or they have children in daycare who are exhibiting symptoms and have elderly family members who are at risk.

Despite claims that the decision to strictly curtail public access to testing was due to limited capacity, at the time that the government cut access, it was doing 50,000 – 80,000 COVID tests per day. Yet the Ford government reported the following in the March 2021 Ontario Budget:

“Laboratory-based polymerase chain reaction (PCR) testing remains the gold standard in diagnostic tests and the province has the capacity to perform 105,000 tests per day. Additionally, over 90 per cent of individuals who have been tested receive test results within two days.”

Clearly either the province has the capacity, as claimed in the budget, and is purposefully privatizing testing as a policy choice, or it does not have the capacity as claimed in the budget. In any case, as a result of the strict rationing of public PCR tests for COVID, testing has fallen to among the lowest rates we have seen since the beginning of the pandemic.

Starting in September 2020, the Ford government began contracting for-profit pharmacies for COVID testing. In November 2021, the province expanded private testing to symptomatic patients, despite concerns about health and safety. Step by step the privatization has expanded. Over the course of 2021 the government began to contract with an array of private for-profit companies to do the swabs, and the contents of those contracts are not public. What changed this year is the Ford government strictly curtailed public testing, forcing Ontarians to use private for-profit clinics or go without. Increasingly, the Health Coalition has been receiving accounts of patients being charged exorbitant prices for COVID tests.

To investigate, the Health Coalition called all of the private for-profit testing companies and chains we could. Coalition Interns said that they had been exposed to COVID-19, had symptoms, and were immunocompromised (thus, had clear medical necessity). The Coalition found five of the for-profit testing clinics and chains selling medically necessary COVID tests for prices that far exceed the public price, usually more than $200 per test. This is a violation of the Canada Health Act and the fundamental principles of Public Medicare in Canada, which forbids charging patients for medically needed services and requires those services to be provided on equal terms and conditions without financial burden for patients. Full details and results are in the Coalition’s briefing note below.

Throughout the pandemic, COVID-19 has been concentrated in low-income neighbourhoods, racialized communities and among essential workers in crowded working environments, yet reliable PCR testing for COVID-19 is now only available for people who can pay $100 – $200 or more per test. Two-tier health care worsens inequities and puts the heaviest costs on people at highest risk. Obviously, there are grave ethical and practical problems with charging patients for access to tests for an infectious and deadly disease during a global pandemic. In addition, there are serious problems with the privatization of who delivers the service: i.e., whether testing is provided in public assessment centres run by public hospitals and health units, or whether it is done in private for-profit clinics and chain companies. Aside from access and equity, safety issues are paramount. In public assessment centres, there are entirely separate entrances, staff in full PPE, high quality trained staff to do the swabs, and other quality and safety protections. In private clinics, staff are often in simple procedure masks and clients may be in cloth masks, both without face shields or N95 masks; in small spaces close together with elderly people waiting for other tests. There are an array of other quality, cost, health system integration and safety issues that result from laboratory privatization outlined in the Coalition’s briefing note.

Quotes:

“To privatize vital public health services in the midst of a pandemic is appalling,” said Natalie Mehra, executive director of the Ontario Health Coalition. “Fundamentally, it is about equity and access to needed care. It is a violation of our core principles to cut off public access then push patients to private for-profit clinics and charge them hundreds of dollars per test for diagnostic testing. It must stop immediately.”

Dr. Gordon Guyatt, professor at McMaster and board member of the Ontario Health Coalition warned that the cut to public testing, “Leaves people who are exposed or who have been exposed at risk of severe and long-term illness.” He went on to challenge the claims that there are not public resources, saying, “The resources are there to do testing publicly, if the government chose to use them.”

“Equal access to healthcare is a fundamental right. Allowing some people to access PCR testing for a fee is unequal and unacceptable. It’s just wrong when you can buy access to health care services and buy the right to live,” added Cathryn Hoy, president of the Ontario Nurses’ Association.

Noting that there are significant quality differences between public lab PCR tests and RAT tests and point-of-care tests, Sara Labelle, a medical laboratory technologist who has been running COVID tests in a public hospital lab throughout the pandemic and is chair of the Hospital Professionals Division at OPSEU sounded the alarm: “The people that are getting sick, don’t have access to the tests… it is a crisis and our government needs to address this. Not tracking how many people actually have COVID is a public health disaster and it means more people are going to get sick with COVID.”

The Ontario Health Coalition called on the Ford government to immediately restore public testing for COVID-19 along with contact tracing and isolation to mitigate the spread of the virus. Further, the Coalition called on Ford to stop the privatization of the delivery of COVID tests and to immediately stop the two-tier sale of medically needed COVID tests.

The video of the press conference is available here.

Click here for printable version of release

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Briefing Note: The Privatization of COVID-19 Testing in Ontario

First, the Ford government cut public COVID testing…

On December 30, 2021, the Ontario government severely restricted access to PCR testing for COVID while the province was in a surge of the Omicron variant. (Omicron BA.1) Since then, only those on a provincially-mandated short list of high-risk people or those working in high-risk settings are eligible for PCR testing. Even people with symptoms and those who have been exposed to the virus — unless they fall within the narrowly drawn eligibility criteria– are not able to access public PCR tests. This means that people cannot get publicly-delivered COVID testing through their local public hospital assessment centre or their local public health unit, even if, for eg., they have GI symptoms and may have Omicron 2 (Omicron BA.2) but cannot be sure whether it is a norovirus or Omicron, or they have children in daycare who are exhibiting symptoms and have elderly family members who are at risk.

As a result of these restrictive measures, the rate of COVID testing has declined precipitously, leaving epidemiologists and infectious disease specialists lamenting the fact that Ontario is now “shooting in the dark” when gauging the severity of the current wave of Omicron 2 and the effect of the eradication of public safety measures. Test-contact trace-quarantine, foundational public health measures for containing the spread of infectious disease, have been abandoned. But while the Ford government has strictly curtailed public testing for COVID-19, and along with it contact tracing and isolation protections, they have given contracts to for-profit chains and companies to massively expand private for-profit testing.

Media report the decision to curtail public testing as though it was a result of inadequate capacity. They were given that impression by the Health Minister who pointed to protecting Ontario’s health system capacity and Dr. Kieran Moore, Ontario’s Chief Medical Officer of Health who said that the rationing of tests was to ensure ‘timely results’ and to “protect testing resources” for those in most need.

These are questionable claims since the Ford government reported the following in the March 2021 Ontario Budget:

“While vaccines are the key to ending the pandemic, stopping the spread of the virus in the meantime remains vital to protect lives….

Timely, high-quality COVID‑19 testing is a critical component to respond to the virus. Ontario has expanded all aspects of testing ranging from COVID‑19 specimen collection, transportation, laboratory analysis and reporting….

Laboratory-based polymerase chain reaction (PCR) testing remains the gold standard in diagnostic tests and the province has the capacity to perform 105,000 tests per day. Additionally, over 90 per cent of individuals who have been tested receive test results within two days.”

The two claims do not accord. When the Ford government cut access to publicly delivered COVID testing it was providing between 50,000 and 85,000 tests per day – not the 105,000 capacity claimed in their budget. Their rationale for eliminating the majority of public testing was that there was not capacity, not that the government had opted to shunt that funding over to for-profit corporations. Bottom line? The evidence shows that Ontario had massive public testing capacity that it is choosing not to utilize. At the same time, the Ford government has chosen to privatize COVID testing.

Number of COVID tests processed per day, Ontario

…and then the Ford government privatized COVID testing

Starting in September 2020, the Ford government began contracting for-profit pharmacies for COVID testing – that is, to swab patients for COVID-19 PCR tests. In November 2021, the province expanded private testing to symptomatic patients, despite concerns about health and safety. However, at the same time, public assessment centres were providing public PCR swab testing for Ontarians across the province. Step by step the privatization has expanded. Over the course of 2021 the government began to contract with an array of private for-profit companies to do the swabs, and the contents of those contracts are not public. What changed this year is the Ford government strictly curtailed public testing, forcing Ontarians to use private for-profit clinics or go without. Increasingly, the Health Coalition has been receiving accounts of patients being charged exorbitant prices for COVID tests.

 

Ontario Health Coalition: Private-Testing Clinic Investigation

To find out how much private facilities are charging for COVID PCR tests, our volunteers called all the private clinics/chain companies doing COVID swabbing that we could find. Between February 15 and March 29, the Health Coalition called 17 for-profit clinics and chain companies that are swabbing for COVID PCR tests. We wanted to see if these private clinics were violating the Canada Health Act. We inquired about getting tested as an immunocompromised individual who had been exposed to COVID-19 and had symptoms, thus, as a person who has clear medical need. Under the Canada Health Act, medically necessary services are to be provided free of charge, covered by our public health care system.

 

Results: Privatization, Two-Tier Health Care and Exorbitant Charges

We found two trends:

1. The for-profit companies that have been contracted by the Ford government are providing publicly-funded swabs for people who are symptomatic. Yet public assessment centres are not allowed to test people who are symptomatic alone. The only explanation for this is that the province is trying to direct patients to private for-profit clinics. This, despite the fact that according to the Ford government’s own claims, there is capacity to do tens of thousands more tests per day than are currently being done.
2. A number of the private for-profit clinics are being allowed to violate the Canada Health Act’s prohibition against user charges for patients for medically necessary services while the Ford government turns a blind eye. The fees are very high – ranging from $129 plus tax to more than $200.

Of the 17 clinics we called, we were able to get clear answers from fifteen. We found five clinics that offered tests for out-of-pocket fees even when we identified ourselves as a person who had been exposed to COVID-19, was symptomatic and immunocompromised. In one clinic, for example, a representative told us, “Yes anyone can get tested at this location. The prices are online. I would recommend doing the next-day testing which is $159 plus tax.” We found that the fees that are being charged are exorbitant and range from $130 to more than $200. Nine clinics referred us back to public health, or said they test only asymptomatic people and/or those who are travelling. LifeLabs tests medically necessary patients with publicly-funded tests for no fee – as noted in #1 above with wider access criteria than the government is allowing public testing sites. We were not able to get any information from two of the clinics/chains. Overall, although some private clinics are acting in accordance with the law, five of the for-profit testing companies are selling medically necessary testing. The list of clinics and detailed results of our investigation are at the end of this briefing note.

 

Private Clinic	Cost of PCR Test	Notes
Integracare	$175 +HST	See notes below.
Vector Health (Pearson)	$159 +HST	See notes below.
Lifeline Pharmacy	$129 +HST	See notes below.
Sante Medic	$199	See notes below.
Strato Labs (Hamilton/Toronto)	$199	No answer so we tried to book online. At no point up to hitting “confirm” on our booking, did the clinic give any limiting criteria for buying a test. Prices are listed on their website.

How Are Private Clinics Funded?

When public health services are privatized, vital information such as the cost our government is paying with our public dollars is hidden from scrutiny in contracts that are secret. The public is not able to get this information. There is little public information about the contracts that the Ford government has made with the array of private testing companies and labs. There have, however, been a few investigative reports from media that raise serious concerns about corruption and sole-source contracts.

FH Health is one of the few private, non-pharmacy companies to be contracted by the provincial government to provide COVID testing. FH was contracted in 2021 to provide publicly-funded COVID testing. In addition, FH Health charges its clients $159 +HST to $350 +HST for RT-PCR testing. In January 2022, Premier Ford awarded FH Health a contract to administer COVID-19 vaccines without competitive bidding. Prior to the awarding of FH Health’s , “each member of its board of directors made the maximum allowable donation to the Progressive Conservative Party under their own names – and all within a few days of each other.” These donations totaled to more than $42,600 from the board members and others with family or business ties to FH Health. The Ontario NDP has urged Elections Ontario and Ontario’s Auditor General to investigate the 17 “potentially coordinated donations” which occurred in September 2021.

 

The Canada Health Act and the Privatization of COVID-19 Tests

The primary objectives of the Canada Health Act are to protect and promote the well-being of Canadians and to ensure reasonable access to comprehensive health services without financial barriers. The Act’s criteria of universality and accessibility require that provinces ensure no financial barrier exists for patient access to medically necessary services.  Further, both federal and provincial law prohibit extra billing and user charges for medically necessary services. Public Medicare in Canada is founded on principles of equity and compassion. Selling of medically necessary COVID-19 tests violates these tenets. Medically necessary health services must be provided and accessible to all Canadians on equal terms and conditions without financial barrier when people are sick and in need.

 

Why Not Privatize?

Throughout the pandemic, COVID-19 has been concentrated in low-income neighbourhoods, racialized communities and among essential workers in crowded working environments, yet reliable PCR testing COVID-19 is now only available for people who can pay $100 – $200 or more per test. Two-tier health care worsens inequities and puts the heaviest costs on people at highest risk. Obviously, there are grave ethical and practical problems with charging patients for access to tests for an infectious and deadly disease during a global pandemic. In addition, there are serious problems with the privatization of who delivers the service: i.e., whether testing is provided in public assessment centres run by public hospitals and health units, or whether it is done in private for-profit clinics and chain companies.

Multiple studies have found private laboratories’ costs to the health system are significantly higher. The latest Ontario government commissioned study found that in 12 small Ontario hospitals that were still processing their community’s laboratory work, the cost was $22 per community patient per year, while in the for-profit laboratories the costs was $33 per community patient. (RPO Management Consultants. Laboratory pilot projects review: final report. Toronto, Ontario Ministry of Health and Long-Term Care; 2008.) The Globe and Mail investigated the rapidly rising costs of vitamin D testing and reported that the private laboratories in British Columbia charged $94 per test, Ontario private labs $52, and Ontario hospitals $32, while the Saskatchewan government (public) lab did the test for $17. The main comprehensive study of Canadian for-profit medical laboratories found costs in the for-profits to be 25% higher. In addition, there have been serious quality concerns, negative impacts on health system integration, and lack of public oversight; and monitoring private labs– if it is done at all– adds extra costs to the public health system. During the pandemic, there has been a significant public outcry about patient safety in private testing sites. Public assessment centres have been set up with entirely separate entrances for testing, staff in full PPE and appropriate safety measures. In the private pharmacies and testing locations, COVID-positive patients may be waiting in small areas with simple cloth masks, nearby elderly and immunocompromised people and staff with simple procedure masks.

 

List of Private For-Profit COVID Test Swabbing Centres & Record of OHC Investigation

Ontario Health Coalition (OHC) script: “Hi. I’ve been exposed to COVID and I’m not feeling well. I have a condition which makes me immunocompromised and I want to get a COVID test done quickly. Would I be able to get one and how much would it cost?”

Walmart Pharmacy – Date/time: February 15, 2022 / 11:39

Response: “We only test asymptomatic clients.”  

Costco Pharmacy – Date/time: February 15, 2022 / 11:35

Costco Response: “Are you travelling?”

OHC:“No”

Costco: “PCR tests are available for travel purposes only.

LifeLabs: Date/time: Attempt 1: February 15, 2022 / 11:06 / was on hold for >6 minutes, did not pick up.

Attempt 2: February 15, 2022 / 11:35 / was automatically disconnected from the call due to high call volumes. Attempt 3: March 23, 2022 / 1045 / was on hold >6 minutes, did not pick up. Attempt 4: March 28/2:12 got through.

Lifelabs Response: “Is it for travelling?” OHC:”No” Lifelabs:”Okay what city are you in? [they listed an array of locations]”OHC:”I have symptoms, do I just walk into a clinic and get a test even though I have symptoms?”

 Lifelabs:”Yes, I was positive myself and I went in. I tried to go on a weekend…when it was less busy.”

Transferred call to Mississauga location. Lifelabs:“Yes, you can get tested.” OHC:”How much does it cost?” Lifelabs:”No charge. We provide tests if you have COVID symptoms…”[They provided a whole list of people who can get tested without out-of-pocket charges at LifeLabs. Notably, they will test people if they have COVID symptoms though the province has disallowed from public assessment centres run by public health and public hospitals.] LifeLabs: “We have lots of appointments. I can book you today.

Swift Clinics – Scarborough:

Date/time: February 15, 2022 / 11:05

Response: “We won’t test you here, it’s supposed to be free for you. You can just call public health and let them know that you are immunocompromised and they’ll give you an appointment.”

Switch Health: 

Date/time: March 23, 2022/10:54

Response: If you’re looking to get one immediately… the best thing to do right now is to contact public health to see what your options are because you can’t go into a Switch Health clinic if you’re symptomatic. Your other option would be to purchase a kit online and have it shipped to you but that takes about 5-7 business days if you want a fast result. So, your best bet would be to contact public health to see what the best option is and I could provide you with their phone number.

HCP Diagnostics:

Date/time: February 25, 2022 / 11:13

Response: “Unfortunately we do not test symptomatic people, so you can’t book an appointment with us.”

Integracare – Toronto:

Date/time: February 15, 2022 / 11:15

Cost: $175 + tax per test

Response: “We book for the next day. If we came out to you since you’re presenting with symptoms it’s $175 + tax per test.”

Curis Medical – Mississauga:

Date/time: February 5, 2022 / 11:12

Response: “We only do it for travellers and asymptomatic people. You would have to get tested publicly.”

Vector Health:

Date/time: February 15, 2022 / 11:29

Cost: $159 +HST for next day RT-PCR

Response: “Yes, anyone can get tested at this location. The prices are online. I would recommend doing the next-day testing which is $159 plus tax.”

Lifeline Pharmacy:

Date/time: February 15, 2022 / 11:20

Cost: $129 + tax.

Response: “You can get it done but it’s not covered anymore so you’ll have to pay out-of-pocket. Yeah, so unfortunately, we don’t have the government ones. I’m not sure if you would qualify for the government sponsored ones. For a PCR it’s $129 + tax.

All Health Medical:

Date/time: February 15, 2022 / 11:33

Cost: Website – RT-PCR Test: $95 + HST, Express RT-PCR Test: $125 + HST

Response:  Automated message: “To make an appointment visit us at www.allhealthtest.com, we will only test asymptomatic individuals. If you experience any COVID-related symptoms, please contact public health for a local testing centre”

Strato Labs:

Date/time: February 15, 2022 / 14:47 Could not get through. March 29 – voicemail full.

Cost: $199 (as listed on website).

Response: Sent directly to an automated message due to high volumes of calls. All booking is done online on their website. We tried booking online and at no point up to the confirmation of our booking (we did not hit confirm) did the website give any criteria for testing. It appears that anyone can book a test for the charges listed on the site.

Sante Medic – Toronto: 1-833-497-0177

Date/Time: February 15, 2022 / 14:50

Cost: $199 inclu tax.

Sante Medic Response: “You can get tested at our facility. If you would like to do it in Toronto, we have only a clinic that works for now in Woodbridge in Vaughan and we have availability for today and if you do this kind of test today, it’s called PCR test for Covid-19, you will receive the results tomorrow at midnight by email.”

OHC: “How much is the cost?”

Sante Medic: “$199 total amount, tax included. The best way to book an appointment for today is just to go online on our website santemedic.ca and book it there.”

Safe Travels COVID-19 Testing – Windsor: 226-773-5252

Date/time: February 15, 2022 / 14:55

Cost: 24 hour results – $150 and 1 hour results – $250

Safe Travels Response: “Are you symptomatic?” OHC: “Yes” Safe Travels: “Unfortunately we do not test symptomatic individuals. Since you have a pre-existing condition, you can probably get tested at one of the health units.”

Swift Clinics Milton

Date/Time: March 23, 2022 / 11:15

Response: “Sorry, we don’t test people who are symptomatic, you’ll have to get tested at another clinic”

Dynacare – Toronto (416) 596-8367

Date/Time: Multiple calls.

Response: Did not answer.

Canada HealthLabs – Toronto 905-525-9140

Date/Time: Multiple calls.

Response: Did not answer.

Click here for printable version of briefing note