Ontario announces plan to increase surgeries at private health care clinics

Premier Doug Ford unveiled a plan to increase the use of private clinics to tackle Ontario’s surgery waiting lists, which the government pegs at more than 200,000 people, but he says the operations moving to such clinics would still be paid for by the public health system.

His government outlined an expansion Monday of the role of private-sector health clinics that focuses first on clearing a backlog of cataract eye procedures, but would then allow existing and new for-profit facilities to perform hip and knee replacements starting next year.

Health Minister Sylvia Jones would not provide target numbers for how many more surgeries Ontario expects private clinics to do once its plan, which would also allow not-for-profit facilities, is rolled out. But Mr. Ford suggested 50 per cent of these surgeries could be done outside hospitals.

The Premier and Ms. Jones announced their plan at a long-term-care home affiliated with Toronto’s Kensington Health, a non-profit private clinic that does eye surgery. But almost all of these existing independent clinics are run by for-profit companies – a major point of contention for Opposition politicians and health care unions criticizing the move.

As the health care system seeks to recover from the strains of the pandemic, Canadians have been experiencing longer emergency-room and surgery waiting times. Hospitals across the country also have been hamstrung by labour shortages that have hampered efforts to tackle surgical backlogs that grew during COVID-19 waves.

Marit Stiles, who is soon expected to be confirmed as the next Ontario NDP leader, warns that the increased use of private clinics is an attack on public health care. Among her criticisms is what she and others say is the common practice of upselling at existing private-sector clinics that ask patients to pay out of pocket for extra procedures not covered by the Ontario Health Insurance Plan (OHIP).

Adil Shamji, a former doctor and the provincial Liberal Party’s health critic, said the government offered too few details on how the new system would be regulated, offering instead “a Broadway spectacle of deflection and non-answers.”

The province’s five largest health care unions issued a statement warning that the expansion of private clinics will only siphon nurses from short-staffed hospitals and vowed to fight it.

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Mr. Ford dismissed his critics for “ideology.” He said one unnamed CEO told him Ontario’s insistence on only public-sector delivery of health care put it in the same league as Cuba and North Korea.

“A lot of people out there, they want to have the endless debates about who should provide care,” Mr. Ford said. “All I care about, all Minister Jones cares about, all our government cares about, is that you get the care you need quickly and safely.”

The first phase of the plan, the government says, will expand the number of cataract surgeries done in clinics outside hospitals, with new clinics performing 14,000 extra publicly funded surgeries in Windsor, Kitchener-Waterloo and Ottawa. This, Ms. Jones said, would eliminate the portion of the backlog attributed to COVID by March.

As a second step, the province is also boosting the number of magnetic resonance imaging (MRI) and computed tomography (CT) scans, also at existing private clinics, officially called “independent health facilities.” Plus, it will allow these clinics to perform more colonoscopies and endoscopies, as early as this year.

The third step in the plan requires new legislation, to come in February. The government said it would allow more existing clinics, and new ones set up via an application process, to do hip and knee replacements, starting in 2024. The legislation, the government said, would also “strengthen oversight” of these clinics, but no details were provided.

Ms. Jones said applications for new clinics would be sought based on the needs of the communities where they would be located. She also said Ontario Health, the superagency that oversees hospitals, would include the new centres in its regional plans. Asked about draining away scarce hospital staff, Ms. Jones said applicants for these new licences would be required to submit staffing plans meant to “protect our public hospitals and to ensure that they are not in any way impacted.”

Anthony Dale, president and CEO of the Ontario Hospital Association, said the new plan ends the “limbo” that the province’s private clinics have been in for 30 years, bringing them into the broader health system. He noted that the government says the new clinics, in their funding agreements, will be required to work with local public hospitals to co-ordinate care. A significant number of the doctors at these clinics will also need to be credentialed at hospitals.

Ontario already has 900 “independent health facilities,” the vast bulk of which do only diagnostics. About 10 do more complex surgeries, most of which are cosmetic. Currently, only a small percentage of all outpatient surgeries are done outside public hospitals. The government points to other provinces, such as Alberta, Saskatchewan, B.C. and Quebec, that make more use of this kind of clinic, which is also common in the U.S.

Questioned repeatedly by reporters, the Health Minister wouldn’t condemn upselling, which critics say is a common practice and sees cataracts patients offered enhanced lenses not covered by OHIP that can cost hundreds of dollars. Ms. Jones would only say that patients charged but never given the option of an OHIP-covered procedure can file complaints with the Ministry of Health.

Bob Bell, former Ontario deputy health minister and hospital CEO, said many outpatient surgeries should be moved out of hospitals, but only to nonprofit centres connected to hospitals. (The Ontario Medical Association had made a similar proposal. It said Monday it looked forward to working with the government to ensure its changes do not harm hospital staffing.)

Dr. Bell warned that the government’s changes may entice hospital staff to leave for better working hours or more pay, given the challenges of COVID-19 and the government’s cap on public-sector wage increases, which is known as Bill 124 and currently in limbo after being struck down by a judge, pending an appeal.

“Nurses are extremely dispirited in Ontario because of Bill 124,” he told The Globe and Mail Monday. “The limitations for doing surgeries in Ontario hospitals are not surgeons, it’s the number of hospital staff and nurses.”

Speaking in Saskatoon, Prime Minister Justin Trudeau said his government will “continue to watch” as provincial governments respond to the health care challenges they’re facing. Mr. Trudeau didn’t directly respond to Ontario’s plan for the increased use of private clinics. But he said there is a need for more money in the system and that he hopes to announce “positive steps forward in the very near future.”

Federal NDP Leader Jagmeet Singh criticized Mr. Ford’s decision, saying in a statement that it will cause longer waiting times for patients. Mr. Singh said world-class health care is best achieved by rebuilding the public system – not by “allowing Conservative premiers to decimate it with American-style for-profit health corporations.”