What happens when privatizing surgical procedures drives up health care costs
As trust in Ontario public health care delivery erodes, officials become more likely to look to private clinics in a desperate attempt to address the crisis.
By Iris Gorfinkel and Andrew Longhurst Contributors
Ontario is on track to rapidly expand surgeries and diagnostic procedures in private, for-profit facilities - though evidence is clear that it will only exacerbate existing staffing shortages in the public system, and leave fewer staff for public hospitals. This in turn will increase wait times and reduce the number of procedures done by the public system, making governments more likely to turn to more costly options to deliver desperately needed care.
One such example is Clearpoint Health Network, a national private-equity-owned surgical chain. A recent CBC investigation reported that the Ontario Health Insurance Program paid this corporation 2.5 times more than public hospitals to perform cataract surgeries, and 3.1 times more for knee arthroscopies.
When asked about this in an interview, Ontario’s Health Minister was quick to justify these payments stating, “It’s really about people having access and making sure that they’re not sitting on wait-lists.”
ARTICLE CONTINUES BELOW
ARTICLE CONTINUES BELOW
This response blithely ignores Ontario’s current critical shortage of health-care workers. Each staff person hired by a private facility leaves one less staff person in a public one. It’s tit-for-tat.
A vicious cycle results: As trust in public health care delivery erodes, officials become more likely to look to private clinics in a desperate attempt to address the crisis. Yet the expansion of private clinics makes staffing public hospitals more difficult. Wait times lengthen and access to public health care worsens, further eroding trust in governments. It’s a cycle that’s become all-too familiar to most Canadians.
At the core, public and private health care have different end goals. The primary objective of private facilities is to maximize profit. Public health care seeks to optimize health outcomes. Putting financial gain at the helm risks patient safety and reduces the quality of care on offer. This was a hard-earned lesson during the COVID-19 pandemic in which private long-term care homes experienced more extensive outbreaks and deaths than public ones.
Bill 60 was passed in May 2023 with the intention to expand the types of surgeries and diagnostic procedures performed in private centres and to entrench them into the public health framework.
This bill fails to prohibit clinicians from upselling unnecessary medical goods and services to patients, even though a 2021 Ontario’s Auditor General report warned that it is common practice. Patients are upsold specialty lenses used for cataract surgeries in for-profit centres even though publicly funded lenses are available.
The bill’s most galling aspect is that the agreements made between the director and private health facilities are kept secret from the public. This helps legally ensure that the director cannot be held accountable. This blatant lack of transparency bars Ontarians from learning how their tax dollars are spent. It makes it impossible to see which privately owned facilities prosper from the public purse — and at what cost. Taxpayers have a right to know exactly where and how their tax dollars are spent. Bill 60 is a barrier to identifying wrongs and a hindrance to making wise investments in health-care delivery.
Iris Gorfinkel is a family physician and clinical researcher in Toronto.
Andrew Longhurst is a Simon Fraser University health policy researcher and author of “At What Cost?”
