Private surgical clinic making life better for New Brunswickers
Last October, the Higgs government introduced legislation that would allow a private surgical clinic to deliver publicly-funded cataract removals in News Brunswick. Originally slated as a 24-month pilot in Bathurst, early evidence of the program’s success has convinced the government to expand it to the rest of the province after just six months.
This is good news for New Brunswickers waiting for cataract surgery, but further reform is needed for patients waiting for other surgical procedures. To understand this success, let's first examine why there’s a need for this project.
For New Brunswickers in 2022, the median wait time between referral from their general practitioner to a specialist and receipt of treatment was 43.3 weeks, the third longest in the country and 15.9 weeks above the national median. After seeing a specialist, the median provincial wait for a cataract removal was 24 weeks, resulting in nearly 4,900 of these procedures for which patients were waiting.
These wait times undoubtedly played a role in the government agreeing to the proposal. So what have been the results so far?
Prior to the surgical suite opening, there were 1,551 patients on the local hospital’s wait list for cataract surgery. As of now, all those patients have had their surgery and just under 500 new patients are now on the list waiting for cataract procedures. Thanks to the capacity this has freed up, 123 other surgeries have also been completed. Simply put, a large number of New Brunswickers are off a wait list and have received medically necessary treatment as a result—all funded by government.
While bold, this type of venture is nothing new in Canada. In 2010, patients in Saskatchewan could expect to wait 26.5 weeks between a referral from a general practitioner and receipt of care, the longest outside Atlantic Canada that year. To address this, the Saskatchewan Surgical Initiative (SSI), a multifaceted plan to reduce surgical wait times, was born. Among other measures, the SSI contracted privately-operated clinics to provide additional capacity. The result was a drop in provincial waits to a median of 14.2 weeks by 2014. In addition to lowering wait times, contracted clinics were also able to deliver surgeries at a cost 26 per cent lower (on average) than their government-sector counterparts.
Unfortunately, in the absence of subsequent reform, wait times eventually crept back up.
Finally, New Brunswick and Canada more generally could learn from the experience of other universal health-care countries. For example, while Switzerland, Germany, the Netherlands and France all spend about the same or less than Canada (as a share of the economy), they perform better on international surveys measuring the timeliness of elective surgical care. In 2020, according to the Commonwealth Fund, Canada ranked last (among 10 countries) for timely access to elective care. Specifically, only 62 per cent of patients in Canada reported waiting less than four months for elective surgeries, far Germany (99 per cent), Switzerland (94 per cent), France (90 per cent) and the Netherlands (87 per cent).
There’s no secret to the success of these countries. They all either partner with their private sector as a pressure valve or an alternative to the public system, fund their hospitals based on activity to incentivize treatment, and generally expect patients to share the cost of care.
The private surgical clinic in New Brunswick, although limited in scope, is beginning to pay dividends. With similar private surgical theatres set to open across the province, experience elsewhere suggests that New Brunswickers will get much-needed relief from a status quo that had previously failed them—at least temporarily. As governments around the country seek to improve health care, this type of experimentation and private-sector involvement will be crucial.
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