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A bed is moved in the COVID-19 intensive care unit at St. Paul's hospital in downtown Vancouver, on April 21, 2020.JONATHAN HAYWARD/The Canadian Press

One of the provinces inspiring Ontario Premier Doug Ford’s decision to expand the use of private clinics to tackle surgical backlogs is bolstering its public health care system at the expense of private operators accused of underusing operating rooms.

The British Columbia government is moving in a different direction from Ontario, saying it is focusing on addressing its waiting list through the public health care system as it – along with other provinces – grapples with scores of surgeries postponed during the waves of the COVID-19 pandemic.

In announcing Ontario’s three-step plan Monday, Mr. Ford pointed to B.C. as one of the provinces already using private clinics in an effort to shorten surgery waiting times. He said Ontario’s plan to expand the types of procedures, including hip and knee replacements, and allow new for-profit clinics to open follows the “best ideas from around our own country,” also citing Alberta and Quebec.

Nearly a year ago, B.C. spent $11.5-million to bring two private surgical centres on Vancouver Island back into the public system, cutting the number of private surgery clinics across the province to seven and just under 5 per cent of all surgeries in the last fiscal year.

By law, the two clinics could only perform simple procedures such as removing cataracts and using an endoscope to examine internal organs before the Vancouver Island health authority took them over, which the province said last year would allow 4,600 more annual operations to be completed in the previously “unused and underutilized” operating rooms.

In 2018, shortly after the New Democrats came to office, the province also bought two MRI clinics in Surrey and Abbotsford, which Health Minister Adrian Dix said would reduce waiting times and costs.

“Our government continues to be a vigorous defender of the public health care system and we believe the best way to serve the people of British Columbia is to build public health care,” the provincial Health Ministry said in a statement when asked about Ontario’s embrace of more private surgeries.

Ministry of Health spokesperson Matthew Wigmore said in a statement that B.C.’s five regional health authorities contract out acute care services every year to free up public operating rooms and diagnostic equipment for more complex overnight procedures. Last fiscal year, they spent $33.5-million on these publicly funded privately performed procedures, which was less than 1 per cent of the $12.5-billion spent over that span, his statement said.

But these surgical centres and other private health clinics are prohibited from charging patients any fees and their “contracting is ended” if such practices are uncovered, his statement said.

A 2017 investigation by The Globe and Mail found significant, unlawful extra billing by Canadian doctors through private clinics – especially in B.C. According to the 2022 Canada Health Act annual report, the province lost $62.8-million of its health transfer portion from the federal government over the four-year period from 2018 to 2021 as a penalty for unlawful extra-billing. There were 45 private clinics operating in the province as of June, 2022, and 17 audit investigations into illegal extra-billing since 2008, but six of those audits are still outstanding.

Sonia Furstenau, an MLA and Leader of the BC Green Party, said provinces need to look at opportunities to strengthen public health care systems, starting with primary care.

“Instead of reacting to this incursion of private health care delivery – or, in the case of Doug Ford, inviting it – what we need are provincial governments that set out to strengthen our public health care systems,” said Ms. Furstenau.

B.C. argued its approach is working: Halfway through the 2022-23 fiscal year, B.C.’s surgery volumes exceeded pre-pandemic levels and operating room hours increased by 5 per cent compared with the same timeframe in 2019.

Ontario’s plan would start with tackling the backlog of cataract procedures by adding 14,000 additional surgeries this year, representing about 25 per cent of the current waiting list.

Ontario’s plan is supported by some medical groups and doctors, including the Ontario Hospital Association, as a necessary step to expand access to timely care. There are currently 10 private clinics and one private hospital licensed in Ontario to perform surgeries.

Data from the Canadian Institute for Health Information show that Ontario had shorter waiting times for most surgeries in 2021 than the provinces it is looking to for solutions. Ontario only lagged behind Alberta, B.C. and Quebec in removing cataracts – with 60 per cent of surgeries being done within the 16-week benchmark. Ontario had the shortest waiting times for hip and knee replacements.

Meanwhile, Alberta continues to offer surgeries through private clinics, which accounted for about 20 per cent of surgeries in the 2021 fiscal year. Last September, the Alberta government announced it was planning to contract more private clinics.

In Quebec, privately operated clinics perform surgeries at no extra charge. Before being re-elected last fall, the Coalition Avenir Québec government said it wanted to build two new private, medical centres in Montreal and Quebec City.

Andrew Longhurst, a health policy researcher at Simon Fraser University, conducted a study last summer through the Canadian Centre for Policy Alternatives looking at extra-billing practices in B.C. and the use of private surgery clinics. The study found that from 2015-16 to 2020-21, the province spent $393.9-million on outsourcing surgical procedures and medical imaging and annual spending increased by 57 per cent.

Mr. Longhurst said it’s a welcome move that the province is expanding public health care delivery as it would address issues around extra-billing and ensure everyone has equal access to services.

The ability to monitor and enforce extra-billing or upselling is a concern that extends to Ontario’s new plan, Mr. Longhurst said, arguing that the cost to the province to ensure proper compliance would be more than increasing surgical capacity in the public system.

“The issues around upselling are very real. We know this is going on and so the more you expand that sector, is there even the enforcement and administrative capacity within Ontario’s Ministry of Health to be able to proactively audit and enforce?” he said.

Mr. Ford has repeatedly said insured services will continue to be covered through OHIP and patients would never pay out of their own pockets.

Steven Staples, with the Canadian Health Coalition, referenced a high-profile Supreme Court of B.C. ruling where the justice determined there was no evidence that private health care would reduce waiting times in the public system and most experts testified that waiting times could actually increase.