Provinces should learn from Quebec and expand use of private health-care clinics
In Canada, the average wait time between seeing a general practitioner and receiving care was 27.4 weeks in 2022. That’s 18.1 weeks longer than in 1993 when wait times were first recorded and 6.5 weeks longer than in 2019, before the onset of COVID.
In response, several provinces including Alberta, British Columbia and Ontario have increased the use of private clinics to perform publicly-funded surgeries. These partnerships also help expand capacity and deliver treatment without costly and time-consuming investments by government in new infrastructure.
Even before COVID backlogs, provinces have used private clinics to help shorten wait times. Consider Saskatchewan. In 2010, the province’s wait between referral from a general practitioner and receipt of care was 26.5 weeks, the longest outside Atlantic Canada. In response, the provincial government introduced the Saskatchewan Surgical Initiative, which included contracts with private surgical centres. As a result, Saskatchewan reduced its median wait to just 14.2 weeks by 2014—the second-shortest in the country that year. And these private clinics were able to deliver surgeries at a cost 26 per cent lower (on average) than their public-sector equivalents.
Quebec has had similar success. A 2005 Supreme Court ruling helped spur legislative action that formally allowed private clinics to perform select surgeries in the province. Initially limited to just three procedures, the list now includes more than 50 different procedures covered in Quebec’s public system that can also be performed in private surgical clinics.
Indeed, private clinics have become an increasingly larger part of Quebec’s health-care system, with the number of private clinics growing from 45 in 2014 to 73 in 2023. In the 50 private clinics where physicians still fully participate in the public system (i.e. opted-in physicians), government covers the costs of medically necessary care. Meanwhile, patients can also choose to pay directly out-of-pocket for care from the 23 clinics with opted-out physicians. Public hospitals are also allowed to outsource certain surgeries to private surgical clinics, if the hospital’s wait times exceed provincial targets. The percentage of publicly-funded day surgeries performed in those private clinics increased from 6.1 per cent in 2011/12 to 17.1 per cent in 2022/23.
Quebec’s health minister has cited the positive impact of these private clinics in helping reduce health-care wait lists in the province—and the evidence is significant. These public-private partnerships significantly increased the number of medically necessary, non-emergency surgeries performed each year, while participating hospitals have reduced wait times to well below the provincial average. These public-private partnerships also made a big difference during the pandemic in Quebec.
Again, other provinces including Alberta and Ontario are also moving in the right direction by expanding the use of contracted delivery of publicly-funded surgeries in an effort to help reduce wait times post-COVID. But more could be done.
Patients should have access to timely health care no matter where they are in the country. And clearly, private contracts can help reduce wait times. With a growing track record of success, provinces across Canada should expand the use of private clinics to deliver publicly-funded services.
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