Premier Doug Ford has said that operations such as knee replacements, hip replacements and cataract surgeries are 'no-brainers' that are backlogging hospitals and could be done at other facilities.Tijana Martin/The Canadian Press
The Ontario government is poised to announce long-awaited details on plans to potentially use more private health clinics, where it hopes to ramp up the number of publicly funded procedures and help clear the province’s surgical backlog.
Hannah Jensen, a spokeswoman for Health Minister Sylvia Jones, would not answer questions about the government’s plans on Thursday, but said it would “have more to share on this early next week.”
Many health services in Ontario, such as blood tests and ultrasounds, are already often performed in for-profit facilities. And both Ms. Jones and Premier Doug Ford have repeatedly said whatever changes to the system they make would still see Ontarians use their health cards – not their credit cards – for needed care.
But any expansion of the role of private for-profit clinics will be extremely controversial, as the health system continues to suffer under the strain of COVID-19 and the flu season.
The Ontario Liberal Party warned on Thursday that expanding private clinics would harm the province’s public health care, moving staff resources out of hospitals and resulting in substandard care.
“What really worries me today is the initially insidious and now entirely conspicuous creep toward privatization in our health care system,” said Adil Shamji, a Toronto Liberal MPP who before being elected last year was as an emergency room doctor.
For months, government and health ministry officials have been examining ways to use what Ontario officially calls “independent health facilities” – which can be for-profit or not-for-profit – to tackle the backlog exacerbated by the COVID-19 pandemic.
In August, as part of the province’s “Plan to Stay Open,” Ms. Jones pledged to increase the number of publicly funded procedures done in “existing private clinics,” as well as to “consider options” for doing more at “independent health facilities.” But her government has not said what types of surgeries were being considered, or whether the limited number of private-sector, for-profit facilities would be allowed to expand or new ones be allowed to set up shop.
Lobbyists for Ontario’s private health facilities have since been making their case to the government, urging it to consider allowing more procedures outside jammed and short-staffed hospitals.
Two years ago, the government issued a call for applications for both for-profit or not-for-profit facilities to take on more cataract eye surgeries, funded by the Ontario Health Insurance Plan (OHIP). The move could have allowed private-sector facilities that currently do laser eye-corrective vision surgery not covered by OHIP, to help reduce long waitlists for publicly funded cataract operations.
But the project has since stalled. The previous Liberal government allowed the creation of a non-profit eye surgery centre, Toronto’s Kensington Eye Institute.
Some doctors, the Opposition NDP and hospital unions have warned that allowing more procedures in private clinics will mean patients are more likely to face “upselling” pressure to pay out of pocket for extra services not covered by OHIP. Health system experts have also warned that expanding private clinics could exacerbate the staffing crisis in hospitals, as more nurses or other staff could be lured to work outside the public system.
The Ontario Medical Association, which represents the province’s doctors, has been pushing for its own reforms, calling for the establishment of “integrated ambulatory clinics” that it says would be not-for-profit specialized surgical centres that would still be overseen by hospitals.
In an interview, OMA president Rose Zacharias said her organization’s plans would take pressure off the hospital system while ensuring that staff are not siphoned away from where they are needed most.
“We have been speaking out very loudly for a while now about our recommendation to deal with the wait-time issues, to deal with the procedural and surgical backlog that we know is really the crisis at hand inside our health care system,” Dr. Zacharias said.
Meanwhile, the body that actually inspects independent health facilities, the College of Physicians and Surgeons of Ontario (CPSO), said Thursday that any new surgical centres need to be attached to hospitals – and that it had not been consulted or informed about any imminent announcement.
“Many months ago, we were consulted and shared our opinion that stand-alone surgical centers need to be connected to the hospital system to ensure continuity of care and patient safety,” CPSO Registrar Dr. Nancy Whitmore said in an e-mailed statement, adding that setting up clinics without any link to a hospital would only worsen staff shortages and wait times for “more urgent hospital-based care.”
In recent days, Mr. Ford himself has hinted publicly that changes are coming. On Wednesday, he said that operations such as knee replacements, hip replacements and cataract surgeries are “no-brainers” that are backlogging hospitals and could be done at other facilities.
Both Mr. Ford and Ms. Jones have repeatedly praised the world-renowned Shouldice Hospital, which specializes in hernia operations and is one of just a handful of private hospitals in Ontario grandfathered when public health care was established decades ago.
“People don’t care where they have to go as long as it has the same regulations,” the Premier said.
Dr. Bob Bell, formerly a deputy minister of health and hospital CEO, warns that for-profit facilities would attract nurses away from the public system, while trying to charge OHIP patients for uninsured services, such as premium cataract lenses.
“This is where people are going to be ripped off,” he said in an interview with The Globe and Mail.
Instead of moving surgeries to private clinics, Mr. Bell said the steep surgery waiting list in Ontario could be addressed by spending more on the current system and using available space in hospitals – as well as moving procedures to not-for-profit facilities.
A 2021 report from Auditor-General Bonnie Lysyk found that operating rooms weren’t being used to full capacity to help clear the backlog. In the 2020-2021 fiscal year, 330,000 outpatient surgeries were performed in hospitals compared with the roughly 440,000 to 455,000 outpatient surgeries in each of the four years prior to the COVID-19 pandemic.
According to the report, there are about 900 independent health facilities in Ontario, with 95 per cent providing publicly funded diagnostic services such as X-rays and ultrasounds. Only 10 are licensed to do OHIP-funded outpatient surgeries, most of which provide plastic surgery. There are just four private hospitals, and their numbers are capped by law.