Will Ontario’s plan to boost surgeries at private clinics work?

If Doug Ford’s doing it, it can’t be good so the thinking goes. But his idea deserves examination.

Private clinics can work if they are run by non-profit societies.

image: Kelly Funk

An example of a successful non-profit clinic is STEPS (Supporting Team Excellence with Patients Society) in Kamloops.

The clinic in Valleyview is owned and operated by the society. Doctors work on a collaborative basis. When my doctor went on maternity leave, another doctor took over. It’s a model that can be used elsewhere according to their website:

“[STEPS] was incorporated on April 11, 2017 as a British Columbia Society whose purpose is to lead innovation in the provision of interdisciplinary team-based primary health care with the goal of developing a successful model of primary care delivery that can be adopted by others.”

 Ford unveiled his government’s plan on Monday. Ontario plans to increase the use of private clinics to tackle Ontario’s surgery waiting lists which is more than 200,000. He claims that clinics would be paid for by the public health system.

Ford says that 50 per cent of surgeries could be done outside hospitals.

Just how for-profit private clinics will be paid for by the public health system is a bit of a mystery. Surely he can’t be suggesting that public money go into the pockets of for-profit clinic operators?

Is Ford suggesting a familiar model by which doctors have operating on since the inception of Canada’s health care?

Some doctors make a good, well-deserved, living by operating private clinics. They bill B.C.’s MSP for each patient visit and if they get enough visits, there will be enough left over after paying staff, utilities, equipment and supplies, rent or mortgage, to live on.

But that model is broken. Not many doctors want to run the business of a private clinic in which they have to work long hours and squeeze in lots of patient visits.

Most doctors would prefer the STEPS model which allows for flexible working hours without the worry of operating a business.

It’s hard to imagine a for-profit private clinic operating with only the income of per-patient visits. They would have to grind through a lot of patients to make it work.

It hasn’t worked for many existing for-profit private clinics. They have had to resort to illegal measures.

“Private surgeries and medical imaging are big business in BC,” says Andrew Longhurst, researcher for the Canadian Centre for Policy Alternatives. “Over the last two decades, this for-profit sector has benefited from increased outsourcing of publicly funded procedures and unlawful patient extra-billing.”

For example, False Creek Healthcare Centre in Vancouver received $12.2 million in health care contracts between 2015 and 2020 despite having been audited by the BC government and found to have engaged in unlawful extra-billing, says Longhurst.

Kamloops Surgical Centre received $15.4 million between 2015 and 2020, also despite having been audited and found to have engaged in unlawful extra-billing. Interior Health continued to contract with the clinic during and after the period of unlawful extra-billing. CCPA Policy Note August, 2022.

Not-profit private clinics have demonstrated that they can function successfully to the benefit of patients and doctors alike. But a for-profit clinic funded by the public purse? Dream on.

Will Ontario’s plan to boost surgeries at private clinics work?

If Doug Ford’s doing it, it can’t be good so the thinking goes. But his idea deserves examination.

Private clinics can work if they are run by non-profit societies.

An example of a successful non-profit clinic is STEPS (Supporting Team Excellence with Patients Society) in Kamloops.

The clinic in Valleyview is owned and operated by the society. Doctors work on a collaborative basis. When my doctor went on maternity leave, another doctor took over. It’s a model that can be used elsewhere according to their website:

“[STEPS] was incorporated on April 11, 2017 as a British Columbia Society whose purpose is to lead innovation in the provision of interdisciplinary team-based primary health care with the goal of developing a successful model of primary care delivery that can be adopted by others.”

 Ford unveiled his government’s plan on Monday. Ontario plans to increase the use of private clinics to tackle Ontario’s surgery waiting lists which is more than 200,000. He claims that clinics would be paid for by the public health system.

Ford says that 50 per cent of surgeries could be done outside hospitals.

Just how for-profit private clinics will be paid for by the public health system is a bit of a mystery. Surely he can’t be suggesting that public money go into the pockets of for-profit clinic operators?

Is Ford suggesting a familiar model by which doctors have operating on since the inception of Canada’s health care?

Some doctors make a good, well-deserved, living by operating private clinics. They bill B.C.’s MSP for each patient visit and if they get enough visits, there will be enough left over after paying staff, utilities, equipment and supplies, rent or mortgage, to live on.

But that model is broken. Not many doctors want to run the business of a private clinic in which they have to work long hours and squeeze in lots of patient visits.

Most doctors would prefer the STEPS model which allows for flexible working hours without the worry of operating a business.

It’s hard to imagine a for-profit private clinic operating with only the income of per-patient visits. They would have to grind through a lot of patients to make it work.

It hasn’t worked for many existing for-profit private clinics. They have had to resort to illegal measures.

“Private surgeries and medical imaging are big business in BC,” says Andrew Longhurst, researcher for the Canadian Centre for Policy Alternatives. “Over the last two decades, this for-profit sector has benefited from increased outsourcing of publicly funded procedures and unlawful patient extra-billing.”

For example, False Creek Healthcare Centre in Vancouver received $12.2 million in health care contracts between 2015 and 2020 despite having been audited by the BC government and found to have engaged in unlawful extra-billing, says Longhurst.

Kamloops Surgical Centre received $15.4 million between 2015 and 2020, also despite having been audited and found to have engaged in unlawful extra-billing. Interior Health continued to contract with the clinic during and after the period of unlawful extra-billing. CCPA Policy Note August, 2022.

Not-profit private clinics have demonstrated that they can function successfully to the benefit of patients and doctors alike. But a for-profit clinic funded by the public purse? Dream on.