Ontario tables health bill that would shift surgeries to private clinics

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The Ontario government says its new draft legislation to allow more publicly funded surgeries and other procedures in for-profit clinics comes with “guardrails” to protect patients and the public health care system.

The bill, unveiled Tuesday, says applicants seeking to set up new private clinics would have to show how they plan to staff up while still protecting the needs of public hospitals. And it says they would be banned from refusing to serve patients who declined to pay out-of-pocket for extra services, an “upselling” practice critics have warned is common at existing for-profit clinics. They would also be banned from charging extra to jump a queue.

The plan, which Premier Doug Ford announced last month, is his government’s proposed solution to the surgical backlogs that have ballooned during the pandemic and now affect more than 200,000 patients in the province.

It’s a problem provinces across the country have been grappling with as the health care system buckles from staff shortages that have forced emergency rooms to close and left patients waiting for procedures and tests. Mr. Ford points to efforts in Saskatchewan, Alberta and Quebec, where governments have also expanded the role of private-sector clinics to tackle waiting lists.

But opposition critics and health care unions warned the measures were not strong enough to stop new private-sector clinics from siphoning scarce staff away from struggling public hospitals or from charging patients exorbitant extra fees. Ontario NDP Leader Marit Stiles warned the move is a step toward “two-tier” health care, even as the government insists the procedures moved into private clinics will be still covered by the public system.

Much of the draft legislation that Ontario’s Health Minister, Sylvia Jones, introduced on the legislature’s first day back after its winter break appears aimed at addressing the government’s critics.

“Based on feedback from front-line partners, the act will in fact put in place significant guardrails to integrate community surgical and diagnostic centres into the health system,” she told reporters.

But her proposed Your Health Act 2023 also leaves a number of questions unanswered. While Ms. Jones says it includes enhanced oversight for private clinics, it does not specify what body would actually regulate them, or do inspections. The bill says a regulator would be named at a later date. Ms. Jones would not say what organizations were being considered for the job.

The College of Physicians and Surgeons of Ontario oversees the province’s existing private clinics, but it has previously raised concerns about the government’s plans. CPSO spokesman Shae Greenfield said Tuesday the body was still reviewing the bill. The legislation does allow for the province’s patient ombudsman to investigate complaints at the new clinics.

Ms. Jones would not say how many new clinics would be set up but said the government would grant licences based on the severity of surgical backlogs in different regions. The Health Minister would also not say how many surgeries would ultimately be shifted to private clinics. Ontario has about 900 clinics now that it calls “independent health facilities,” most of which do diagnostics, such as X-rays. Only a small percentage of overall surgeries are done in private clinics or in the province’s handful of private hospitals.

Ontario’s plans, announced last month, included a move to immediately shift thousands of cataract eye procedures from hospitals into existing private eye clinics, followed by an expansion of the diagnostic tests that private clinics can do. In 2024, the government says it plans to allow more hip and knee replacements in an expanded number of for-profit, or not-for-profit, clinics.

On Tuesday, Ms. Stiles, the NDP Leader, said the bill’s guardrails were not good enough to protect patients from gouging or the public system from decaying. She said the Ford government had created a crisis in the province’s health care system through underfunding and a legislated cap of nurses’ wages, which was recently overturned in court but that the government is seeking to appeal.

“There will be a two-tier system here,” Ms. Stiles said. “This is just the beginning of it, and this government is opening the door.”

The government points to other safeguards in its bill. Those applying to open new clinics would be required to outline how their centre would “integrate with the health system.” Ontario Heath, the government agency that oversees hospitals, is also supposed to ensure that the new clinics are included in regional planning and report into the province’s waiting times information system.

In addition to submitting staffing plans meant to protect the “stability” of hospital staffing, new clinics would also be required to show how they consulted with public hospitals before winning a licence. The bill would also require all physicians working at these clinics to have privileges at hospitals.

Kevin Smith, the president and chief executive officer of Toronto’s University Health Network, welcomed provisions that would require the new clinics co-ordinate with public hospitals. But he said he’ll be watching closely to see how they are put into practice.

“The devil will be in the details,” he said.

The Ontario Medical Association, which represents doctors, has been touting its own plan calling for stand-alone, but non-profit, specialized surgical centres to ease the burden on hospitals.

While OMA president Rose Zacharias said the bill would help relieve the strain on the health system, she said her “strong recommendation is that [the clinics] are not-for-profit.” Nothing in the proposed legislation would prevent for-profit operators from applying for a licence.

Doris Grinspun, the CEO of the Registered Nurses’ Association of Ontario, said she is concerned that “investor-driven” private surgical centres will cut corners as they put shareholders ahead of patients. She said she is worried about patient safety if hip and knee surgeries are offered outside hospitals, without ready access to emergency departments and intensive-care units.

CUPE’s Ontario Council of Hospital Unions warned that expanding private and for-profit surgeries would increase costs, worsen patient outcomes and take staff from public hospitals. The union is planning to join the Ontario NDP in a protest against the legislation on Wednesday.

With a report from Laura Stone

Editor’s note: A previous version of this article used an incorrect title for Doris Grinspun, CEO of the Registered Nurses' Association of Ontario. This version has been corrected.