If cutting surgical wait-lists is the only goal, Doug Ford's plan could work

Now that Ontario Premier Doug Ford has unveiled his government's plan to reduce surgical wait-lists by giving a greater role to privately run for-profit clinics, the big question is whether the plan will succeed.

Hip, knee replacements cost Ontario some $600M yearly; for-profit clinics could get share of that

Ontario Premier Doug Ford standing, with two medical chairs behind him.
'Ontarians will always access health care with their OHIP card, never their credit card,' said Ontario Premier Doug Ford during a news conference on Monday to announce the government's plan to reduce surgical wait-lists. (Frank Gunn/The Canadian Press)

Now that Ontario Premier Doug Ford has unveiled his government's plan to reduce surgical wait-lists by giving a greater role to privately run for-profit clinics, the big question is whether the plan will succeed.

A key factor in how that plays out is the definition of success.

Ford and Health Minister Sylvia Jones are not claiming their proposal, which was announced Monday, will fix all the problems in the health system — merely that it will speed up the pace at which patients get certain surgeries and procedures. 

"We're taking action to reduce wait times for surgeries," Ford told the news conference. "No matter where you live, we want to connect you to more convenient care closer to home."

Hospital administrators know that if they devote more resources to one specific part of the health-care system, it can show results. 

That means if all the Ford government wants to accomplish is reduce wait times for cataract surgeries and hip and knee replacements, the plan has a shot at achieving that goal, provided it's done right. 

X-ray scan image of hip joints with orthopedic hip joint replacement.
Surgeons in Ontario perform about 25,000 hip replacements every year. The average wait from a decision to operate until the surgery is performed is about six months. (Shutterstock/ChooChin)

Anthony Dale, chief executive of the Ontario Hospital Association, acknowledges that the plan will face challenges.

"We have a huge amount of change management and risk management ahead of us if we're to successfully implement this," Dale said in an interview. 

The role of specialized clinics

There's widespread agreement that some surgeries could be performed more efficiently — without sacrificing the quality of care — in specialized clinics outside of hospitals.

LISTEN | Jones says expanding private care won't worsen hospital staffing crisis:

Sylvia Jones is Ontario's Deputy Premier and Minister of Health. She is the MPP for Dufferin-Caledon.

The issue that stirs impassioned debate is whether those specialized clinics should be run on a non-profit basis under hospital management or on a for-profit basis under the private sector. 

The Ford government's plan allows both the non-profit and for-profit models. That's what makes the plan both politically defensible and politically charged.

Defenders of private sector involvement will point out that numerous facilities in Ontario providing publicly funded health-care operate on a for-profit basis. Most of those are performing diagnostic testing, such as X-rays, ultrasound and pulmonary function tests, but there are also dialysis and sleep clinics. 

Expanding this to some of the most commonly performed surgeries opens the door to a new revenue stream.

Ontario says as many as 14,000 additional cataract surgeries can be performed each year through its new plan for community surgical and diagnostic centres in Windsor, Kitchener-Waterloo and Ottawa. (CBC)

The plan begins with a major expansion of cataract surgeries outside hospital this year, and aims to see hip and knee replacements done in community surgical centres starting next year.

Roughly 150,000 cataract surgeries are performed in Ontario every year. With OHIP proposing to pay $605 each for these, that creates the possibility of a $90-million industry. Private-sector laser clinics are keen to get a piece of that action.

Ontario does roughly 32,000 knee replacements and 25,000 hip replacements every year. At an average cost in hospital of $10,500, according to the Canadian Institute for Health Information (CIHI), that puts $600 million in play.

The NDP's soon-to-be leader, Marit Stiles, drew attention to the money at stake. 

"There are a lot of people out there looking to turn a profit off of [health care], the biggest line in the government's budget," said Stiles during a news conference Monday. "We're talking public dollars shifting over into private shareholder pockets." 

This graphic from the Canadian Institute for Health Information shows the percentage of hip replacements performed in 2021 within the national benchmark of six months after a physician orders the surgery. Ontario leads the country, at 75 per cent.
This graphic from the Canadian Institute for Health Information shows the percentage of hip replacements performed in 2021 within the national benchmark of six months after a physician orders the surgery. Ontario leads the country. (CIHI)

Stiles said cataract surgeries and hip and knee replacements are not where the health-care system's crisis is to be found.

In fact, Ontario is the best place in Canada to be waiting for a hip or knee replacement. Ontario gets more of those surgeries done within the nationally targeted time frame of six months than any other province, CIHI figures show

200,000 waiting for surgery

The government says it's on track to eliminate the pandemic-related backlog of surgeries by March. But all that means is that Ontario will pare its surgical wait-list down to where it was before COVID-19 hit the province: roughly 200,000 people waiting for an operation. 

About one-quarter of those are ophthalmic surgeries (including cataracts), and one-quarter are orthopedic surgeries, such as hip and knee replacements, says the Ministry of Health.

One of the big concerns is whether the creation of specialized clinics will bleed staff away from hospitals.

The government insists that won't happen, but the details are not sketched out yet, as shown by a quote in the province's own news release. 

"We look forward to working with the government to develop a strategy to make sure these new centres do not take resources away from hospitals or exacerbate existing health human resources challenges," said Dr. Rose Zacharias, president of the Ontario Medical Association, in the release. 

Dr. Melanie Bechard, a pediatric emergency physician in Ottawa and chair of Canadian Doctors for Medicare, is skeptical.

"This plan provides us new places to provide surgery, but it doesn't provide us any new people to provide surgery," Bechard said in an interview. "Ultimately, these facilities are going to be competing with our public hospitals for staff."

WATCH | Ford government unveils plan for reducing surgical wait-lists:

Ontario to expand surgeries available at for-profit clinics

2 months ago
Duration 3:58
Ontario is significantly expanding the number and range of medical procedures performed in privately run clinics. Premier Doug Ford says the move is necessary to improve surgery wait times.

Ford and Jones repeatedly insisted Ontarians will pay for these surgeries "with their OHIP cards, not with their credit cards."

That simply means the government will not break the law: under the Canada Health Act, provinces cannot charge residents for medically necessary services. 

Reference to Cuba, North Korea

The government is keenly aware of the potential backlash if its plan is perceived as privatization of the health system. Officials chose the non-profit Kensington Health as the location for the announcement, and in the first sentence of her opening remarks, Jones stressed the phrase "not for profit."

Yet Ford frequently talks about how government should be run like a business, and that the private sector is more efficient than the public sector. 

He may have revealed more than he intended with one of his off-the-cuff remarks during the news conference.

When talking about the need for change, Ford quoted an unnamed hospital CEO, who apparently told him, "There's only two places in the world that have the health care that we have, the same system. It's Cuba and North Korea." 

Ford did not disagree with the CEO's comparison.


Mike Crawley

Senior reporter

Mike Crawley covers provincial affairs in Ontario for CBC News. He began his career as a newspaper reporter in B.C., filed stories from 19 countries in Africa as a freelance journalist, then joined the CBC in 2005. Mike was born and raised in Saint John, N.B.

With files from Aarti Pole

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