Canadian province's healthcare fix raises fears of new strain on public system

By Anna Mehler Paperny

TORONTO (Reuters) - Ontario's plan to rely more on private operators for public health services has some doctors and patient advocates worried it could put patients at risk of exploitation and steal workers away from a public system facing a staffing shortage.

Canada's most populous province on Monday announced a major expansion of private providers for publicly covered procedures such as cataract surgeries, joint replacements and medical imaging. Ontario Premier Doug Ford said the move was needed to address an unsustainable status quo of long wait times.

But the move has run into opposition from some unions, doctors and patient advocacy groups who fear it will subject patients to out-of-pocket fees and cannibalize an already strained public healthcare workforce, despite promises from the government that it will not.

Ontario has some private healthcare providers but they are a small part of the health system and provide relatively few public surgeries. Critics worry sharply expanding their footprint will take staff from the pool of public health workers.

The province says it is working to bring in more workers but it remains unclear if that will be enough to satisfy the needs of the public system along with an expanded private one.

"What we have now is an opportunity for nurses to be pulled out of the public system … and have perhaps an 'easier day' in a surgical centre than what they're doing in hospital," said Michael Warner, a critical care physician at Michael Garron Hospital in Toronto.

Doctors and patient advocates also fear the change leaves patients exposed to up-selling - being encouraged to buy additional or pricier services - or paying for services covered by public insurance.

A December 2021 Auditor-General's report found that even with limited independent operators providing outpatient surgeries "there has been no provincial oversight of surgery providers to protect patients from being misled about their right to receive the standard publicly funded surgery without having to pay any fees out of pocket."

The law prohibits charging for publicly insured services or for preferential access, a spokesperson for Health Minister Sylvia Jones said, adding the province will work to inform patients about inappropriate charges and explore tracking fees providers charge for services alongside publicly covered procedures.

Patients can also ask for an investigation if they are not offered a publicly funded option for care, Jones said on Monday.

In 2021, the Commonwealth Fund ranked Canada's health system tenth out of 11 rich countries. The United States ranked last.


Over 2020-21, 10 private operators in Ontario performed 16,400 surgeries, while the only private hospital conducted 1,800, according to the Auditor-General's report. By comparison, 330,000 outpatient surgeries were conducted in public hospitals.

Monday's plan would ramp up cataract surgeries to 14,000 a year and lay the groundwork for independent clinics - some of which are for-profit - to perform more surgeries and medical imaging.

Ontario's government said it is following the lead of provinces such as Alberta, which contracts with private providers and said last fall it will fund more surgeries in private clinics.

No one disputes Ontario's health system faces serious challenges. Some critics of the new plan say moving surgeries out of hospitals to private clinics is the right move because community-based clinics could provide non-emergency care more efficiently - though they do not think such clinics should be for-profit centres.

"The question is, should this be done by for-profit or not-for-profit organizations?" said Bob Bell, an orthopedic surgeon and former Ontario deputy health minister.

The Ontario Medical Association, which represents doctors, said it supports the province’s plan.

"We need a surgical backlog catch-up solution and a structure to deal with wait times," said President Rose Zacharias, adding the facilities should be integrated with hospitals and a healthcare staffing strategy prepared.

Prime Minister Justin Trudeau on Monday did not comment on the Ontario plan other than to say he is "watching" to ensure it complies with the Health Act, whose tenets include public administration, universality and accessibility of health care.

(Reporting by Anna Mehler Paperny; Editing by Denny Thomas and Deepa Babington)