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TORONTO — The Ontario government’s plan to expand the use of for-profit corporations to provide surgeries and diagnostic procedures won’t reduce wait times and is likely to increase them, a new report from the Ontario office of the Canadian Centre for Policy Alternatives says.
“Increasing surgical and diagnostic capacity depends on the availability of qualified staff, which is not magically increased by the addition of profit,” says report author Andrew Longhurst. “Expanded outsourcing is likely to worsen public hospital staffing shortages that cause longer waits.”
In May 2023, the Ontario government passed new legislation (Bill 60) to encourage growth of the for-profit sector in health care. Longhurst called that “the wrong direction” based on the evidence of what currently ails the system.
“A review of the research literature and policy experience shows for-profit delivery worsens public sector staffing shortages, costs more, and introduces conflict of interest in medical decision-making, which can lead to upselling, self-referrals, and unnecessary procedures,” said Longhurst. “Improving the public system, not undermining it, is the sensible approach.
“Ontario does not lack the physical space and equipment to improve wait times for surgeries and medical imaging; what is missing is the health care workforce and funding necessary to do the work.”
While Ontario’s overall per capita funding of health care is the lowest in Canada, Ontario wait times for many priority procedures are the shortest in Canada, the CCPA report found.
Longhurst, a Simon Fraser University health policy researcher, is concerned that Ontario is set to repeat the mistakes of Alberta, a province that saw wait times increase and total surgical volumes decline as public funding and staffing were diverted into investor-owned centres.
“Ontario had the shortest wait times for hip and knee replacements in Canada in 2022 and has consistently performed better than the Canadian average since 2010. Despite Ontario having the shortest MRI and CT wait times in recent years, diagnostic imaging is likely to see the greatest expansion of for-profit delivery under the government’s plans,” Longhurst says. “Why would Ontario repeat Alberta’s policy mistakes? The system is not broken, just underfunded.”
In 2021-22, less than two per cent of surgeries in Ontario were performed in for-profit facilities. However, the Ontario government’s plans to grow the number of privately performed surgeries and do more for-profit imaging risks entrenching unlawful extra-billing (two-tier health care) and encouraging a for-profit industry aimed at diverting health care dollars to private investors in Canada and the U.S.
There is a better way, Longhurst’s report shows: The province could reduce wait times by increasing and improving public delivery of surgical and diagnostic services: funding and staffing underused public hospital operating rooms (and performing surgeries during evenings and weekends); increasing hospital bed capacity; implementing single-entry and team-based referral models; reducing the overuse of clinically inappropriate diagnostic imaging and surgeries; increasing access to seniors’ home and community care to help reduce hospital overcrowding; and adopting a “vaccines-plus” public health strategy to prevent surgery cancellations and reduce health system strain.
At What Cost? Ontario hospital privatization and the threat to public health care contains detailed recommendations to avoid the pitfalls of for-profit health care and improve wait times by strengthening the public system. Visit www.policyalternatives.ca to download.
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For more information or to arrange interviews, please contact Amanda Klang at [email protected] or 514-996-3515.
