Ontario Government's Reduction of Medical Wait Times by Financing Private Clinics

  Barbara Biley and Peggy Morton

Demonstration in Toronto against Ford government's health care plans, December 12, 2022.

On January 16, the Ford government in Ontario announced a three-step plan to enable private health care facilities to undertake certain types of surgeries and other medical procedures, "to eliminate surgical backlogs and reduce wait times" through private clinics, which it refers to as "community surgical and diagnostic centres."

In its January 16 announcement, it claims, "There are currently 206,000 people estimated to be waiting for surgical procedures. For reference, last fall, there were approximately 209,000 patients waiting for a hospital operating room-based surgical procedure in Ontario, and about 200,000 before the pandemic." It says its plan will return wait lists to pre-pandemic levels by March 2023, barring any "operational issues."

In Step One, the government proposes to tackle the backlog in cataract surgeries by contracting private health facilities in Windsor, Kitchener-Waterloo and Ottawa to perform an additional 14,000 cataract surgeries each year, which according to the government represents some 25 per cent of the "province's current cataract waitlist, and accounts for the estimated COVID-related backlog of cataract surgeries." The government adds that it is investing more than $18 million in existing private medical facilities to undertake "more than 49,000 hours of MRI and CT scans, 4,800 cataract surgeries, 900 other ophthalmic surgeries, 1,000 minimally invasive gynecological surgeries and 2,845 plastic surgeries such as hand soft tissue repair."

In Step Two, the Ontario government plans to expand the capacity of private community surgical and diagnostic centres to address regional needs regarding "cataracts, as well as MRI and CT imaging, colonoscopy and endoscopy procedures." It said the focus will be procedures that are "non-urgent, low-risk and minimally invasive and, in addition to shortening wait times, will allow hospitals to focus their efforts and resources on more complex and high-risk surgeries."

In Step Three, the Ford government plans to introduce legislation in February to enable private diagnostic centres "to conduct more MRI and CT scanning so that people can access publicly funded diagnostic services faster and closer to home. Starting in 2024, this next step will also expand surgeries for hip and knee replacements." The government adds that the legislative changes will also "strengthen oversight of community surgical settings so that patients can continue to expect to receive the world class care they know and deserve and provide the province with more flexibility to continue to expand access to more surgeries and further reduce wait times."

The Ford government announced as well that as Ontario "expands the role of community surgical and diagnostic centres, Ontario Health and the Ministry of Health will continue to work with system partners and clinical experts to put in place the highest standards for quality and safety." Premier Ford also stated to the press that these changes will be permanent.

Surgical Backlogs and Pertinent Questions

A report issued by the Ontario Medical Association (OMA) in February 2022, titled A Three-Stage Approach to Addressing Ontario's Critical Surgical and Procedural Wait Times pointed out, "Under the province's current structure, hospitals have been regularly operating at 100 per cent or greater capacity. OMA analysis suggests that the health-care system would need to work at 120 per cent capacity for up to 31 months to clear most of the backlog. In May 2022, the OMA said there was a backlog of nearly 22 million health care services, including 1 million surgeries.

The OMA data follows a recent report by the province's Financial Accountability Office that showed it will take more than three years and $1.3 billion to clear the backlog of surgeries and diagnostic procedures in Ontario. Persistent delays have detrimental impacts on both patients and providers that compound the challenges that need to be addressed."

In May 2022, the OMA also said that the Ontario government should:

- Invest money for staff, infrastructure and a streamlined system to reduce wait times and service backlogs.

- Expand mental health and addiction services.

- Improve and expand home and other community care to reduce reliance on hospitals and long-term care.

- Strengthen public health and pandemic preparedness.

- Give every patient a team of health-care providers that can interact digitally, as there are 1.3 million Ontarians who currently don't have a family doctor.

Some pertinent questions that come to mind.

Where did the government get its figures about the backlogs, and why is there such a discrepancy from the figures provided by the OMA?

Why is it prioritizing cataract procedures, or any of the other procedures to be dealt with in its plan? What these surgeries have in common is that they both require implantation of medical devices cataract surgery involves placing an artificial lens, while joint surgery involves a prosthesis or artificial joint. Both provide the opportunity to "upsell" from the standard provided through the OHIP system, with patients offered a "choice," paying the cost difference which can be thousands of dollars, making these clinics highly desirable for private interests who are interested in maximum profit.

Further questions include, that if the government has not identified, quantified and qualified the size and nature of Ontario's surgical backlog, then what is the aim of its three-step plan?

What is happening to address the longstanding demands of health care workers for proper working conditions which are the guarantees for patients' well-being?

(With files from Government of Ontario, OMA, CBC)

This article was published in
Volume 53 Number 2 - February 2023

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