Expansion of private clinics likely to increase wait times in Ontario, report suggests

Ontario’s plan to allow more for-profit clinics to conduct surgeries and diagnostic procedures is likely to increase wait times rather than reduce them, a new report suggests.

The report, released Thursday by left-leaning think tank Canadian Centre for Policy Alternatives, suggests that for-profit surgical and medical imaging was a half-billion-dollar industry in Ontario between 2021-22 and that an expansion into this sector will only worsen the public health staffing shortages.

“I'm very concerned to see the government moving in this direction when Ontario has actually been a fairly well integrated and coordinated system, in large part because it hasn't farmed out surgeries to a cottage industry of for profit facilities,” Andrew Longhurst, health policy researcher at Simon Fraser University and author of the report, told CTV News Toronto.

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According to Longhurst’s report, Ontario had the best wait time performance for hip and knee replacement surgeries in Canada last year. About 72 per cent of hip replacements and 68 per cent of knee replacements were conducted within the national benchmark of 26 weeks.

“Ontario is actually one of the best performers among all the provinces for hip and knees and MRI and CT scans,” Longhurst says. “And these are the four areas where we have heard the government is most likely to expand for profit delivery.”

In May, the Ontario government passed Bill 60, which allowed private clinics, both non-profit and for-profit, to conduct more surgeries covered under the Ontario Health Insurance Plan (OHIP). The procedures covered include cataract surgeries, MRI and CT scans, minimally invasive gynecological surgeries and, eventually, knee and hip replacements.

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The government has stressed that these procedures will remain covered under OHIP. However, experts and advocates have expressed concern about oversight, staffing and upselling—three of the most significant issues outlined in Thursday’s report.

“Ontario does not lack the physical space and equipment to improve wait times for surgeries and medical imaging; what is missing is the health-care workforce necessary to do the work,” the report notes. “When surgeries and diagnostics are outsourced, the public and for-profit sectors compete for a limited pool of specialized health-care professionals.”

“The private sector may offer incentives to attract health-care workers from the public system, such as reduced workloads, less complex patients, and higher pay.”

In a statement provided to CTV News Toronto, Ontario's Ministry of Health said there will "always be those who are opposed to innovation," in response to the report's findings.

"But our government is not okay with the status quo. That’s why, as part of Your Health, we announced in January that we are further leverage [sic] community surgical and diagnostic centres to deliver more publicly funded surgeries and procedures to reduce the surgical backlog and overall wait times," a spokesperson for the ministry wrote. 

"Our plan has already reduced the surgical backlog to pre-pandemic level, adding 14,000 additional OHIP covered cataract surgeries annually and 49,000 hours of MRI and CT scans, with 80% of all Ontarians now receiving surgery within the target time," the spokesperson added.

Between 2019-20 and 2020-21, operating rooms in Ontario lost 122 full-time equivalent staff, the report notes. The loss of staff in the public sector places more burden on not just hospitals but the health-care system as a whole, the report argues.

“If you don't have enough patient flow happening through your hospitals, you can't move people through the hospital and you're constrained in terms of the number of inpatient surgeries you can do,” Longhurst said.

Instead of focusing on for-profit care, the government should instead ensure that operating rooms are able to work at full capacity, Longhurst says. According to the report, about 34 per cent of hospitals had unused operating room capacity in 2019-20.

“Additional capacity can be created by extending OR hours, but a significantly expanded for-profit surgical sector will be competing for the same skilled staff,” the report says.

PROTECTING PATIENTS FROM EXTRA-BILLING

Over last two decades, patients in Ontario have been reimbursed more than $3 million for unlawful extra-billing, the report suggests. In 2022, there were 43 complaints related to the Commitment to the Future of Medicare Act. The report notes that 35 per cent were “verified contraventions.” The report does note that the number of complaints and contraventions are at historic lows, however Longhurst says “it’s still an issue.”

“I think we would be we would be mistaken and I think government would be mistaken to say that extra billing and two tier health care is not an issue in Ontario,” he said.

The report argues that a complaint-driven enforcement regime will result in a conservative estimate in the number of unlawful extra-billing.

While Bill 60 specifies that a physician at a private clinic shall not turn a patient away for choosing to pay with their OHIP card, it does not prevent upselling or self-referrals. The Canadian Centre of Policy Alternatives is suggesting there should be measures outlined in legislation to protect patients.

An MRI machine in an undated file photo. (AP Photo/Keith Srakocic, File)

While the government has promised to designate “expert organizations” to work with Ontario Health and the Ministry of Health to ensure quality and safety standards are met, advocates argue its not enough to combat instances of what they call “manipulative upselling.”

The Ontario Health Coalition, which advocates for publicly-funded health care while representing more than 500 member organizations and individuals, previously shared testimonies from patients in which people paid out of pocket for procedures. In some instances, patients said they were urged to get upgraded lenses, told they had to incur the costs of eye measurements, and invoiced for contrast dye needed for imaging.

The costs, according to the coalition, were anywhere from a few hundred dollars to over $8,000.

“I think we need to be live to the reality that this activity will continue as you see and you grow this for profit industry,” Longhurst said.