Ontario’s Move to Increase Surgeries at Private Clinics Follows Successful Saskatchewan Example

Ontario's Health Minister Sylvia Jones speaks with media at Queen’s Park in Toronto in a file photo. The Canadian Press/Christopher Katsarov

The decision by the Ontario government to contract out more surgical services has been welcomed by some health experts who say a similar initiative in Saskatchewan reduced wait times and saved tax dollars.

Premier Doug Ford and Health Minister Sylvia Jones held a news conference Jan. 16 to announce that private clinics would receive more contracts to do cataract surgeries, hip and knee replacements, foot surgeries, and medical scans. The impetus is to reduce wait times, which soared during the pandemic and have not returned to 2019 levels. However, the premier also indicated that the approach will remain even after that benchmark has been met.

Another Canadian province made a similar shift more than a decade ago. When the Saskatchewan Surgical Initiative was launched in 2010, 15,234 surgical patients had waited longer than three months for surgery, and 1,587 had waited more than 18 months. After five years, those numbers had dropped to 1,751 and 52 respectively.

Last fall, SecondStreet.org, a think tank that supports more market-based solutions to Canadian health care, made queries to the Saskatchewan Ministry of Health about the initiative. In answers published online, spokesperson Dale Hunter reported that since 2010, about 15 percent of Saskatchewan surgeries have been done privately each year, though complications from the pandemic bumped this number to almost 20 percent in 2021–22.

“All procedures were performed below the cost of the public system,” Hunter wrote. “Assessments showed that the difference between per-procedure costs in public hospitals and private surgical centres are roughly 35 per cent in plastic surgery and general surgery day procedures, and up to 45 per cent in orthopedic day procedures.”

In an interview with The Epoch Times, SecondStreet.org president Colin Craig said the Ontario announcement is not “some magic bullet solution” to health-care woes, but one step in a necessary journey.

“A number of provinces have done what Ontario’s announced ... and it’s helped them ultimately reduce wait times for patients and in many cases actually reduced costs to the system, too. So it’s a win-win, and we think that Ontario is going in the right direction,” Craig said.

“They want to get these types of procedures out of hospitals and into clinics, so that hospitals have more space and staff to handle things like patients who need heart operations, cancer treatment, and more serious types of health procedures. That’s a step in the right direction.”

A Leger poll conducted for SecondStreet.org last October reported that 59 percent of Ontarians said government should pay private and non-profit clinics to perform surgeries, procedures, and diagnostic scans to reduce waiting times for patients, with only 23 percent opposed.

A smaller proportion of the Ontarians polled, 48 percent, said people should be allowed to spend their own money for health care at a private clinic, with 40 percent opposed. And 69 percent said provinces should reimburse patients for surgery outside of their home province or country, with just 15 percent opposed.

“Public opinion has really changed over the years,” Craig said.

“We’re now at a point where majority of Canadians support going even farther and having the choice to use their own money at private clinics. That was very difficult to communicate 20 years ago, whereas now the public is there, [although] the politicians aren’t quite there yet.”

‘Criticisms Not Well-Founded’

Janice MacKinnon, professor with the School of Public Health at the University of Saskatchewan, said even in medicare’s home province, private clinics have won patients over.

“I know people who were very critical of the idea of the clinics before they were sent there. And then they went there and they thought, this is easy. They’re in a mall or something, you drive up, you don’t have to go through the hospital parking. You’re not walking through a hospital which is a place that you can get infections that are problematic,” MacKinnon said.

“Some of the criticisms are just not well-founded. One of the criticisms is, the clinics will take the easy-to-treat cases and leave the public system with the difficult cases. Well, if you look at Saskatchewan, the health districts decided which patients would go to the clinics.”

MacKinnon said public sector unions are the only potential losers from more privately provided care, as fewer workers would pay union dues. Third parties were required to make human resource plans to do medical procedures in Saskatchewan, and MacKinnon said the details proved private clinics weren’t compromising public care.

“Many of the people that ended up in the clinics were people who had left the profession, but came back because the clinics offered something incredibly valuable to health-care workers, a Monday-to-Friday nine-to-five job with no emergency call-ins,” she said.

MacKinnon listed some of the advantages private clinics provide.

“Private clinics can offer huge advantages if the government does a good job at getting the right contract,” she said.

“They’re cheaper and faster because they focus on one procedure, one or two. That’s all they do every day. Also, they’re not unionized. That doesn’t mean the salaries are lower, but they don’t have the restrictions that are in union contracts. So they have more flexibility. If they’re really busy tomorrow, maybe somebody will stay for an extra hour, but next week, they can take that time off.”

‘Very Frustrating’

MacKinnon, who was finance minister under Saskatchewan’s Roy Romanow government in the 1990s, said the Ontario government needs to structure the contracts to ensure quality care at reasonable prices, and in this way the use of private services should not cause alarm.

“It’s very frustrating to continue to see this debate in Canada that would occur in no other part of the developed world,“ she said. ”Every other developed country has private clinics where the services are paid for by the government. They don’t debate that, it’s just part of the system, and many of those countries have better health results.”

Dr. Brian Day founded the Cambie Surgical Centre in Vancouver in 1996 and is taking his legal fight to the Supreme Court of Canada to  enable private health insurance in B.C. He says government data suggests that Ford’s plan “could save hundreds of lives” annually.

“The B.C. College of Physicians keeps the data on complications that happen in private clinics, everything that goes wrong—if you have to have a readmission, if the patient gets an infection. Their data shows that complications in public hospitals are 40 times more common than they are in private surgery centres,” Day said in an interview.

“You may have heard of these superbug infections, the ones that eat away and cause very serious infections. They happen in 11 of every 1,000 discharges in public hospitals. We’ve treated 85,000 patients over the years at Cambie and we’ve never had one. For every 100 hospital admissions in a public hospital in Canada, there is one preventable death. [At Cambie] since 1996, we’ve had no deaths.”

Day said public hospitals get annual funding from government that makes every service rendered a loss, whereas private centres are paid for every service they provide.

“We don’t want to treat patients because they cost money, so it’s a crazy system. We should do a Monty Python show on the Canadian health system. There is a lot to work with. The system is designed to put patients at the bottom,” he said.

“A private facility that’s on a contract is getting revenue for every patient they choose. It’s pretty simple arithmetic.”