Supplementing Health Care With Private Clinics Could Cut Wait Times, Study Finds

The entrance to the emergency department at Peter Lougheed hospital in Calgary on Aug. 22, 2023. The Canadian Press/Jeff McIntosh

A successful Saskatchewan program could serve as a roadmap to tackling the ever-growing issue of long health-care wait times in Canada, says a new study from the Fraser Institute.

The province launched the Saskatchewan Surgical Initiative (SSI) in 2010 to address escalating medical wait times by using private clinics for essential non-emergency surgical procedures such as knee and hip replacements.

The program was key to reducing Saskatchewan’s waiting times by 47 percent between 2010 and 2014, the study found. There was also a nearly 75 percent reduction in the number of patients waiting for surgery for more than three months.

“The success of the Saskatchewan Surgical Initiative offers valuable lessons for policymakers across Canada—and hope for patients—that the unacceptably long waits that plague health-care systems nationwide can be reduced meaningfully with sensible reform,” Fraser Institute senior fellow Nadeem Esmail said in a press release.

The SSI program worked by compiling referrals province-wide to more efficiently pair patients with available specialists as well as by using private clinics to carry out publicly funded procedures. Over the five-year period the SSI was in place, the average medical wait time from when a patient was referred by their family physician to a specialist to when the treatment was completed fell by 47 percent to 14.2 weeks.

This decrease moved Saskatchewan from having some of the longest wait times for medical care in Canada to some of the shortest. Wait times in Canada’s other provinces did not fall during that time, the study pointed out, adding that wait times in Saskatchewan “increased substantially” after the SSI ended in 2014.

The problem, according to the study, is that the use of private clinics in Canada continues to be a “highly controversial” practice despite the prevalence of private surgical procedures in “most high-performing universal health-care systems.”

“Contrary to criticisms of the SSI, universal access to health care in the province was not compromised by outsourcing medical procedures to privately owned for-profit clinics,” the study said.

That’s because outsourcing to private clinics was controlled by a number of requirements and regulations put in place not only to protect patient access to publicly provided care, but to keep costs in check.

“Saskatchewan’s experience with the SSI suggests that publicly-funded surgeries outsourced to private clinics can serve as a beneficial first step on the road to reform,” Mr. Esmail said. “The benefit of replicating this approach, if not adopting an enhanced and bolder version of it, would be more timely access to care for patients with better value provided for taxpayer dollars.”

Wait Times in Canada

The average national wait to see a specialist after being referred by a general practitioner came in at 14.6 weeks in 2023, while ​​the wait time from specialist appointment to treatment was 13.1 weeks, according to the Fraser Institute’s annual “Waiting Your Turn“ report released last December. That makes the overall average wait time in Canada 27.7 weeks.

The 27.7-week figure was the longest wait time in the report’s 30-year history and is 198 percent longer than the 1993 average of 9.3 weeks.

The data, which was collected in a survey with responses from 1,200 Canadian doctors across 12 specialties and 10 provinces, singled out Nova Scotia as the province with the longest wait time: 56.7 weeks. Prince Edward Island and New Brunswick had similarly high wait times of 55.2 weeks and 52.6 weeks, respectively.

Average wait times in Alberta, Newfoundland, and Saskatchewan came in at 33.5 weeks, 33.3 weeks, and 31 weeks while Manitoba averaged 29.1 weeks. British Columbia’s average wait time was 27.7 weeks and Quebec’s was 27.6 weeks. Ontario patients had the shortest wait time with an average of 21.6 weeks.

Long wait-lists for health care is the main reason why more than 50 percent of Canadians surveyed by Ipsos in April said they were dissatisfied with their provincial health-care systems and were in favour of relying more on private entities to provide better service. The idea was particularly popular in Quebec, with 65 percent of respondents expressing support.

Canadians looking for answers outside of their current provincial system is not completely unexpected considering the impact that rising wait times is having on specialists, according to in-house research by the federal Department of Health.

The 2023 report found that shortcomings of Canada’s publicly funded health-care system are causing anxiety for many Canadians who fear “delays in tests or treatment.”

“While the actual care received rarely tended to be a source of concern or criticism, most participants wanted to raise their concerns and fears about access to services and delays in tests or treatments,” the report found.

The majority of those surveyed described medicare as adequate only after patients managed to make it through extensive queues, wait lists, and quotas.