The Ford government recently announced plans to use more private clinics to help with Ontario’s surgical backlog. Ontario wouldn’t be the first province to do so, and based on the experience of other jurisdictions, it would be a positive step forward to help Ontario’s struggling health-care system. But for long-term improvements, such initiatives must be augmented by more fundamental reforms.
According to a recent survey of physicians, patients in Ontario faced a median wait of 20.3 weeks between seeing a general practitioner and receiving treatment in 2022. That’s the longest wait recorded in the province in three decades, and more than twice as long as Ontarians waited in 1993 when the Fraser Institute first published nationwide estimates. While these data reflect wait times for elective treatment (i.e. scheduled treatment, not emergencies), these treatments are medically necessary and include colonoscopies, cardiac care and so on. And the waits can be agonizing for patients and families and lead to poorer health outcomes, permanent disability or even death.
Of course, the pandemic and subsequent scale back (or outright cancellation) of certain surgeries affected wait times and the system’s ability to deliver care. But the same survey reported a pre-COVID median wait time of 16.0 weeks in 2019, which indicates a structural problem. In other words, the pandemic exacerbated—but is not the primary cause—of the province’s challenges.
Which takes us back to the Ford government’s new plan. Partnerships with the private sector can help reduce wait times by expanding capacity to deliver treatment. Provinces such as British Columbia and Quebec have used contracts with private clinics for years, including to help with surgical backlogs from the pandemic. The Alberta government also plans to expand the number of surgeries by private clinics, with an eye on wait times.
And with good reason. Private clinics have proven to help jurisdictions reduce wait times. Consider Saskatchewan. In 2010, the province’s wait between referral from a GP and receipt of care was 26.5 weeks, the longest outside Atlantic Canada. In response, the Saskatchewan government introduced several initiatives including the use of 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. However, when the contracts ended, wait times in Saskatchewan crept back up, underscoring the need for larger reforms.
To achieve lasting improvements in health care, Ontario can look to other successful universal health-care countries. Some reforms can be done without Ottawa’s involvement. For instance, Ontario could finance hospitals based more on the procedures and services delivered to patients (known as “activity-based funding”) and move away from simply funding hospitals based on the previous year’s spending, which is to some extent removed from the actual services provided. Such activity-based funding is common in many universal health-care countries—including Australia, Switzerland, the Netherlands and Germany—which often outperform Canada on many key measures including wait times.
Larger scale reforms, such as changing the way health care is financed more broadly, require both federal and provincial changes, but Ottawa has indicated no interest in reforming federal health regulations, which currently impede innovation, nor changing our health-care system to most closely resemble other universal health-care countries who achieve better outcomes.
Increased use of private clinics can go a long way to reduce wait times in Ontario and bring relief to patients and their families. But for lasting improvements, Ontario’s health-care system requires fundamental reform.
Tegan Hill and Bacchus Barua are economists at the Fraser Institute.