Ontario’s Privatization of Surgery Is a Threat to Canadian Health Care

Ontario premier Doug Ford is outsourcing surgical procedures, handing health care provision over to entities that oppose Medicare. The measure is another step toward the dismantling of public health care in Canada.

Ontario premier Doug Ford and deputy premier and minister of health Sylvia Jones at a news conference in Toronto announcing the privatization of health care services. January 16, 2023 (R. J. Johnston / Toronto Star via Getty Images)

Last week, Doug Ford’s Progressive Conservative government laid out its plans to privatize 50 percent of surgical procedures. The measure has been made possible by the crisis in Ontario’s health system, induced by years of austerity that have left hospitals underfunded. Ford’s action will not, however, solve the crisis. What it will do is ensure that some health care administrators, executives, and physicians profit at Ontarians’ expense.

Under the new plan, surgical procedures — chiefly cataracts, MRIs, CT scans, and hip and knee replacements — will move from hospitals into “Independent Health Facilities” (IHFs).

“That will allow additional capacity at the hospitals to do the serious surgeries,” Ford said.

A special type of out-of-hospital facility, IHFs usually cover surgical, therapeutic, and diagnostic and dialysis procedures and plastic surgery. While the Ford government stresses that some of these facilities operate, like hospitals do, as incorporated not-for-profit entities, the reality is that 97 percent of IHFs are for-profit corporations.

“Let’s get the cataract surgeries, get the backlog there. Let’s change people’s lives, and take care of the hip and knee replacement surgeries,” Ford said. “You add ’em all up, what I understand is that’s 50 percent of the surgeries.”

“We’re going to chip away at this,” the premier said. “This will be permanent.”

Upselling And Cost Cutting

CBC News estimates that privatizing cataract surgeries alone, at $650 each, could generate a $90 million industry off of public funds. Hip and knee surgeries cost, on average, $10,500 each and total roughly 139,000 cases per year. As CBC News notes, “Private-sector laser clinics are keen to get a piece of that action.”

While the name “Independent Health Facilities” may sound complicated, for-profit health care operates much like other for-profit industries — it generates profit by some combination of cost cutting and price hiking. Plans to expand IHFs have been stalled by high-profile cases of patient injury. In 2012, the province’s College of Physicians and Surgeons noted that 29 percent of “out of hospital premises” (one category of private clinics) fall short of safety standards in some way.

More recently, the college noted it has warned Ford’s government that outsourcing surgeries to private facilities will come with risks to staffing and safety. Ford, however, dismissed these concerns. “I was shocked to hear that they would come out and say that,” Ford told a press scrum. “You should ask them if they have confidence that they can handle it.”

In 2021, Ontario’s auditor general concluded that private clinics carrying out cataract operations have carried out “widespread” abuses. The report found many cases of firms pushing patients to buy expensive lenses to qualify for surgery ranging from $450 to almost $5,000 per eye. In many cases, these clinics deliberately deceived patients into believing that the costly specialty lenses were mandatory.

Asked if the government would do anything to curb these excess user fees, Health Minister Sylvia Jones dismissed them as merely cases of patients choosing among various health care “options.”

“I wouldn’t call it upselling, I would call it patient options,” Jones said.

Who Benefits?

Leading up to the 2022 provincial election, Telus, Shoppers Drug Mart, Switch Health, and other major corporations led a lobbying blitz to privatize and outsource parts of the provincial health system, especially virtual care and lab testing. Other firms, many of them recently established, also pushed to expand IHFs. These included the WELL Health–affiliated MyHealthCentre and Northwest Healthcare, chaired by a member of the Ford government’s “Healthcare Audit Committee.” WELL Health is Canada’s largest owner and operator of outpatient health clinics.

Ford has been open about his personal contact with unnamed health care CEOs in drafting the proposal. “One CEO, and I won’t name him, said,” according to Ford, ‘There’s only two places in the world that have the health care that we have — the same system — is Cuba and North Korea.”

Support for the plan goes beyond these existing corporate entities. Despite concerns from the College of Physicians and Surgeons, the plan has been endorsed by the lobby for Ontario’s hospitals, the Ontario Hospital Association (OHA), as well as the Ontario Medical Association (OMA) and a number of other health care interest groups.

As the National Post observed: “The outpatient plan is supported by the Ontario Hospital Association, the Ontario Medical Association and multiple hospital CEOs. Don’t be surprised if it’s hospitals themselves that lead the way by establishing satellite surgery centers.”

The OMA support is hardly surprising. As Ford himself has said, many of these private health facilities will staff or, in many cases, count Ontario’s doctors as executives. Ford vowed that most of these private, for-profit clinics will be staffed by “the same top-notch doctors that are working in the hospital.”

OHA CEO Anthony Dale likewise said, “Ontario’s hospitals have a long history of leadership in clinical innovation and working collaboratively to implement new ways to reduce wait times and deliver exceptional patient-centered care.”

Both the OHA and OMA have supported privatization efforts in the past. In the 1980s, the OMA’s federal counterpart, the Canadian Medical Association, was adamant, according to former health minister Monique Bégin’s account, that “all sources of private financing of health insurance should be permitted.” Since then, a good number of medical professional associations have been quick to champion privatization.

In the 1990s, then OHA CEO David MacKinnon declared that the drive to partner with the private sector was already “guiding our hospital system.” This was made easier, he noted at the time, by the fact that “many members of hospital boards and a disproportionate number of the board chairs are business people.”

Ford is transparent about who his allies are in the implementation of the new measures: “we’re making the changes with the support of the CEOs and with the associations.”

Chronic Conditions

While Ford’s own support of privatization isn’t surprising — he has, after all, previously vowed to privatize “everything that isn’t nailed down” — the scheme to privatize Canadian health care extends much further than Ford’s office.

From the start, private interests were written into Canada’s public health care plan. The ensuing tension between private and public sector advocates in Canadian health provision has been near-constant. Medicare became a Canada-wide program in 1968, when the implementation of the Medical Care Act was accepted by all provinces and territories. That act, however, mirroring existing provincial programs, only aimed to cover hospital costs and medically necessary physician expense.

While opting to fund hospitals and physician fees with public insurance programs, the liberals, conservatives, and social democrats of the day were careful not to “socialize” or “nationalize” the health care system or implement a system of “state medicine.”

Despite the demands of labor and other social movements at the time, this has left gaps in the system of public coverage, eagerly filled by profiteers. By the 1990s, 25 percent of health services were delivered by the for-profit sector, average physician fees had risen sharply, frontline health care workers faced cuts and public health administrators, as noted above, were looking for new, private partnerships. These trends have only continued since.

Medicare’s shortcomings allowed incorporated physicians and health entities to drive up fees, suffer staff burn out, and back calls to further privatize. This is also why moving facilities out of hospital or endinghospital-centric care” has too often been a Trojan Horse for for-profit delivery — in home care, long-term care, and in surgical centers.

The crisis in Canada’s health system is real. Across the country, emergency departments (EDs) are overwhelmed, their beds are full, and patients are dying. But, as we’ve noted before, this crisis is a recurring one, caused by decades of cutbacks and speedups. While there may be good reason to move these select surgeries out of hospitals to free up hospital beds, there is no reason why these procedures — and the system itself — cannot be fully funded and publicly delivered.

Ending the crisis, however, will likely require more than just an injection of funds. The system needs to be democratized. Many of those who have been put in charge of the health system — CEOs, audit committees, and the like — by both Liberal and Tory governments oppose the principles of Medicare. This layer of profiteers will need to be replaced — along with governments that do their bidding — by representatives for health care workers, communities, and medical professionals committed to the cause of universal, public provision.