Government-Funded Surgeries in Quebec Increasingly Performed by Private Clinics: Study

A surgery is performed in the operating room in Toronto's Hospital for Sick Children on Nov. 30, 2022. (The Canadian Press/Chris Young)

Private surgical clinics are playing an increasing role in Quebec’s universal health-care system, performing one in six publicly funded day surgeries in 2023, according to a new study.

Released on Sept. 26, the study from the Fraser Institute says government-funded day surgeries performed by private clinics increased from 6.1 percent in 2011 to 17.1 percent in 2023 in Quebec.

“Quebec has increasingly used private clinics as part of its universal health care system, particularly during and after the COVID-19 pandemic to reduce the surgical backlog,” said study author Yanick Labrie, senior fellow at the institute, in a news release.

“The Quebec experience shows that private clinics are a complement to, and not a substitute for, the public system.”

Mr. Labrie noted the increased use of public-private partnerships followed a 2005 decision by the Supreme Court of Canada that allowed private surgical clinics to perform select operations covered by the Quebec health-care system.

“The central element in the trial was the length of waiting lists and its consequences, as this symbolized the failure of the public health care monopoly,” he wrote.

“It also called into question the morality of prohibiting private medicine, insofar as patients who see their health and quality of life deteriorate under the monopoly system have no alternative.”

‘Same Opportunities’

In response to the Supreme Court’s ruling, the Quebec government tabled Bill 33 in December 2006, amending the “Act respecting health services and social services.” This allowed private clinics to perform only knee or hip replacements and cataract surgeries at the time, when wait times were “the most problematic.”

The study noted that after the province introduced a new regulation in 2009, nearly 50 specialized medical treatments were added to the list, with the vast majority being cosmetic and ophthalmological surgeries.

Citing data from Quebec’s Commission on Health and Social Science, the study found that the number of private surgical clinics in Quebec has grown from 45 in the first quarter of 2014 to 73 in the first quarter of 2023.

More importantly, according to Mr. Labrie, the legislative change allowed public hospitals in Quebec to enter into agreements with private surgical clinics to outsource certain surgeries when the public system cannot meet its waiting time targets.

“Other provinces can look to the Quebec experience with public private partnerships in health delivery to see what is possible even within the Canada Health Act,” the author said.

“Canadian patients everywhere should have the same opportunities to access timely care no matter where they are in the country, including private clinics which are thriving in Quebec.”