These Canadian provinces tried fixing wait times using private clinics, and failed

Canadians all want shorter wait times for medical services like diagnostic imaging, surgeries and cancer treatment. 

A recent poll by Environics Research for the Canadian Health Coalition shows that British Columbians are split on the old debate of whether privatizing parts of the healthcare system might help us get there. 48 percent think it wouldn’t help, and 40 percent at least somewhat agree it might. 

Thankfully, we have no shortage of evidence to help us resolve the debate. Three Canadian provinces have recently tried relying on the private sector to improve wait times within a publicly-funded system. They’ve all ended up proving that this approach is worse for patients. 

The Alberta Surgical Initiative a step backward for wait times

In 2020, the Alberta government announced a plan to outsource $400 million worth of surgeries to private, for-profit facilities, stressing that all outsourced surgeries would be publicly paid for. With ambitious goals of doubling the number of outsourced surgeries over three years, the Alberta Surgical Initiative (ASI) promised to reduce wait times by growing surgical capacity. 

Four years later, all evidence shows that the ASI has accomplished the opposite of its stated objectives. Recent government figures show that privatization has reduced surgical capacity in Alberta’s hospitals, while overall provincial surgical capacity has continued to drop. 

Here’s a snapshot of what’s happened since the start of the ASI:

• Surgeries performed in the private sector have risen from 15 percent in 2020 to 20.5% in 2023-2024
• The use of public operating rooms dropped significantly. In the past year, 4,800 fewer surgeries were performed in the public sector 
• Total surgical volume has declined 6%, with Alberta now performing fewer surgeries than in 2014-2015 
• Wait times have in Alberta are now some of the worst in the country and continue to worsen at a faster rate than the Canadian average

In summary, increased outsourcing to private clinics has failed to improve overall surgical capacity and Albertans are waiting longer than ever for their surgeries. 

Quebec’s pilot proved privatization costs more

In 2016, Quebec’s then-health minister Gaétan Barrette set out to prove his theory that giving public money to private surgical clinics could save the healthcare system money overall. He launched a pilot project to compare the costs of five major surgeries in the public system with costs of same surgeries in three private clinics. 

Barrette was so confident in his project that insisted that the data on costs be collected in a standardized way and made public. Then, for years, he affirmed that the pilot was a success but failed to release the results. In 2023, researchers finally got hold of the data through a freedom of information request.

Barrette’s plan backfired by undoubtedly proving that the same publicly paid for surgeries cost dramatically more when performed in private clinics. For example, in 2019-2020, the cost of a carpal tunnel surgery averaged $908 in a private clinic and $495 in the public system. A colonoscopy cost $739 in a private clinic, almost three times the $290 it cost when performed in a public hospital. 

Part of the reason the private surgeries cost so much more is that the contracts with the clinics guaranteed that the government would cover costs plus a ten percent profit margin. Unsurprisingly, this approach incentivized an increase in costs. Over the course of a couple of years, the overall costs in private clinics for almost all types of surgeries studied increased. 

Ontario’s privatization opened the way for illegal, two-tiered health care

The Ontario government is making significant investments to expand publicly funded surgeries and diagnostic procedures in for-profit facilities. New legislation (Bill 60), passed in May 2023, will enable the growth of this for-profit sector despite all evidence pointing to a well-performing public sector with untapped capacity. 

Ontario Premier Doug Ford made a headline-grabbing promise that Ontarians would never have to pay with their credit card for surgeries under his new privatization plan. He also promised strong “guardrails” to protect patients from extra-billing and user fees, which are banned under the Canada Health Act and provincial legislation. 

Instead, extra-billing and user fees have exploded with increased privatization. According to Natalie Mehra, executive director of the Ontario Health Coalition, “the widescale extra-billing and charging user fees to patients never happened before the for-profit clinics began to take over our public hospitals’ surgeries, and, in our experience, it has never been worse than it is now.” 

An Ontario Health Coalition report released in April 2024 summarizes 120 cases of extra-billing, with 18 detailed case studies. Fees have ranged from $50-$8000 and are often accompanied by misinformation about the availability and coverage of public services. 

This recent trend is consistent with experiences in other Canadian provinces, including BC, which shows that for-profit clinics have experienced significant growth based on a mix of public contracts and unlawful billing. Given this precedent and business model, it would be unwise to expect that offering more for-profit clinics public contracts would put an end to unlawful billing. 

No shortage of evidence

Canada has seen decades of failed privatization experiments throughout our health care system. Still, outsourcing surgical and diagnostic services to private for-profits is often described as a new innovation to reduce wait times. 

Taking a serious look at the data and evidence leads us to acknowledge that British Columbia, Quebec, and Alberta, which have the most for-profit clinics and hospitals, generally show poorer wait times performances than provinces with little to no privatization. 

If we truly agree on the goal of shortening wait times, it’s time to also agree that we need less privatization and profit-taking in our system, not more. 

Resources

Data shows privatization has reduced surgical capacity in our hospitals |Friends of Medicare Alberta

Failing to Deliver: The Alberta Surgical Initiative and Declining Surgical Capacity | Andrew Longhurst, Parkland Institute

Gaétan Barrette proved that private healthcare costs more than public healthcare | Anne Plourde, Institut de recherche et d’informations socioéconomiques

At What Cost? Ontario hospital privatization and the threat to public health care | Andrew Longhurst, Canadian Centre for Policy Alternatives

Illegal, Unlawful and Unethical: Case Studies of Patients Charged for Medical Care in Ontario’s Private Clinics | Ontario Health Coalition