Jan 01, 2013

Parking: Who should pay?

Hospitals: they can be large or small; historic buildings or sleek, modern facilities that function like mini-cities; patient-centred...or patient-terrifying. In this series, we’re looking at the challenges of providing non-clinical services — parking, environmental responsibilities, patient meals, building and room design, and security — and how some facilities are innovating

In November 2011, an editorial in the Canadian Medical Association Journal called hospital parking fees a barrier to health care, saying the charges amount to “parking-centred health care,” and recommended hospitals stop charging patients for parking. The editorial stirred up a debate in the media. The Ontario Nurses’ Association, for one, agreed with the recommendation and noted that many of its members could tell stories about patients who had avoided seeking care or had cut appointments because of high parking costs.

Tom Badcock is the executive director of the Physically Disabled Service Centre in St. John’s and a cancer outpatient at the city’s Health Sciences Centre. He is campaigning against the practice of charging patients for parking, claiming that such costs contravene the Canada Health Act because they constitute indirect user fees. After complaining to the hospital administration and the provincial health minister to no avail, Badcock told local media he planned to file a lawsuit against Eastern Health.

Some argue that parking fees should remain in place as a deterrent to our car-happy culture — particularly in urban centres, where public transit is both readily available and encouraged. Considering the all-hours nature of life and work in hospitals, however, not to mention the harshness of Canadian winters, expecting hospital workers and visitors to use public transportation is probably not going to be met with enthusiasm, particularly in towns that are underserved by transit. And patients who live in rural areas have no choice but to drive into town for care.

One of the main arguments against abolishing parking fees is that hospitals often use these revenues for chaplaincy, foundation programs and other patient services. In Ontario, hospitals receive only 85 per cent of their budget from the health ministry and therefore, some would argue, need the estimated one per cent of revenue that comes from parking fees. Others ask, if parking structures were not revenue generating, who would pay to maintain them? Should hospitals be expected to cover the cost of snow removal, for example, in their already constrained budgets?

Some hospitals have gone so far as to contract out their parking to private, for-profit companies such as Impark, which manages parking facilities for nearly 100 health-care centres across North America. In the case of a new hospital, a public-private partnership may see a parking company take on not only the operation but also the construction and maintenance of the parking garage. Hospitals can reduce costs by contracting out parking, but the people who have to park in privately managed lots are paying the price. The Internet is full of complaints about the high fees and predatory ticketing practices that often come with privatization.

There are some signs of greater accommodation. Parking fees for patients, visitors and staff were abolished at hospitals in Scotland and Wales in 2008, except in privately owned lots. Several hospitals in North America have recognized the needs of patients and are trying to make parking less painful. Children’s Hospital Colorado in Denver provides free parking to patients and visitors and even offers a complimentary valet service from 6 a.m. to 6 p.m. The Vancouver Island Health Authority offers free parking for renal dialysis patients at all its hospitals. Here’s hoping these trends toward people-centred parking continue.

More than 300 nurses walked off the job in Western Australia one day last fall to attend a rally to protest increases in parking rates for staff and patients. A representative from the Australian Nursing Federation noted that costs at Sir Charles Gairdner Hospital in Perth rose from AU$1.50 per day in 2010 to AU$4.80 per day in 2012 (a 220 per cent increase) and that in some locations, costs were projected to increase sevenfold in the next three years.

Think some of the daily maximum rates hospitals charge for parking are outrageous? In some hospital lots, there is no daily maximum — the meter never stops running. The emergency lot at Vancouver General Hospital charges $3.25 per half hour, which means a 24-hour stay costs $156.

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