Universal health insurance and equal access to care, funded by taxes paid to governments, is the definition of medicare. It is also fundamental to Canadians’ gauzy self-image.
That image is in part defined by what medicare is not: for-profit health care in the United States. And that’s why whenever the word “private” floats into the perennial debate about how to improve widespread underperformance in medicare, there’s a recoil. Ontario Premier Doug Ford encountered that knee-jerk reaction this week as he announced relatively modest reforms that would give private surgical clinics a modestly larger role in the province’s health care system. For some, the use of the word “private” anywhere near the phrase “health care” implies the start of a descent into an American mess.
Reality differs from rhetoric. Large portions of Canadian medicare have always been delivered by private entities, from doctors to pharmacies – which administered many free COVID-19 vaccines. The public pocket pays private providers. That’s the key.
Where universal health care fails to live up to its promise is when Canadians cannot get timely access. Too-long wait times for common surgeries such as cataracts, knees and hips were a problem two decades ago and they remain a problem today. In 2021, all three of these surgeries fell way short of benchmarks, with one-third, or more, of patients waiting longer than promised, according to the Canadian Institute for Health Information. In a 2021 study of peer countries by the Commonwealth Fund, Canada ranked ninth out of 11 in access to health care.
The problem is clear but solutions are less obvious. What is certain, however, is the need to keep trying new approaches. The status quo is failing.
Ontario last summer floated a plan to perform some surgeries in private clinics. On Monday, Mr. Ford outlined the proposal. To clear a pandemic backlog, more cataract surgeries will be outsourced, a plan already under way. The province next month will table legislation to do more knee and hip surgeries, along with scans such as MRIs, in clinics. Mr. Ford repeated his refrain that Ontarians would pay with their health card, not their credit card.
This space has long supported a role for private clinics in publicly funded health care. Clear goals must be set – reducing wait times should top that list – and measuring and publishing results on a timely basis is essential. But Ontario’s plan does not allow for anyone to buy their way to the front of the line (as has been proposed by Dr. Brian Day in British Columbia).
Ontario’s challenge is to make its plan work. Other provinces have tried but results are lacklustre so far.
Alberta first moved some surgeries to clinics in the early 2000s. More than three dozen private clinics do 15 per cent of the surgeries in the province. The aim is to increase that to 30 per cent. In B.C., about 4 per cent of surgeries are outsourced, which did help to clear the pandemic backlog. The most recent data show wait times for hip and knee replacements are longer in B.C. and Alberta than in Ontario. The western provinces have better results on cataracts but still fall well below the benchmark target.
In Saskatchewan, the province in 2010 included private surgeries in an effort to cut terrible wait times. It was a big success, for a while, but the latest data show the province’s wait times are back to as bad as they were in 2010.
In Ontario, the process by which Mr. Ford unfurled his plan has left many key questions unanswered. It wasn’t debated during last year’s election campaign. Staffing at hospitals is a big worry. Critics argue there will be an exodus of doctors and nurses to private clinics. Ontario says it will require clinics to submit staffing plans. Alongside shorter wait times, another important goal of Ontario’s reforms is to allow overworked hospitals to focus on more difficult surgeries. But if hospitals are stripped of scarce human resources, Ontario’s plan is destined to fail.
Blind fear of private delivery of publicly funded health care ignores how Canada’s current system functions and shuts down debate on much-needed reform. But, equally, to believe private clinics are a simple solution ignores the mixed results from other provinces. Ontario is smart to step away from the status quo, but success is not a foregone conclusion. Done carefully, done well, the province’s reforms could work.