Lessons from the Public-Private Partnerships in Surgical Care in Quebec

Long wait times for surgical treatments have been a persistent issue in Canada and have worsened since the COVID-19 pandemic (Moir and Barua, 2022; Labrie, 2023). In an effort to tackle the long backlog of elective surgeries, various provincial governments have in recent months announced plans to partner with private surgical clinics (Daflos, 2023; Ferguson, 2023; Smith, 2023). Although such public-private collaborations have proven successful in the past (MacKinnon, 2016), debate rages in Canada about the potential to improve access to surgical care through increased partnerships with the private sector.

In this context the experience of Quebec is interesting to analyze, as such partnerships have existed there for more than 15 years.1 Although it has a universal health care system that must comply with the principles of the Canada Health Act, Quebec has experimented with implementing specific public policies and programs that differ significantly from those of other provinces in several key respects. Since the Chaoulli judgment in 2006, private services for select procedures have been fairly commonplace. More recently, many more cases of publicly funded day surgery have been outsourced to private medical centres, with the aim of alleviating the backlog created during the COVID-19 pandemic. At the beginning of April 2023, Quebec Health Minister Christian Dubé also announced the intention of his government to continue along this path and promote public-private partnerships in the health care system in the future (Vailles, 2023b).

This essay documents Quebec’s relatively unique approach to health care in the Canadian landscape in order to show the compatibility—and potential benefits—of public-private partnerships within the framework of a universal health care system. After briefly describing the events surrounding the Chaoulli ruling and the subsequent government response, the report examines the factors underlying the expansion of private surgical centres in recent years. It concludes with the main lessons to be learned from the Quebec experience so far, and some conditions that would need to be met to take full advantage of the presence of entrepreneurs in this area of our health care systems.