Premier Doug Ford and Health Minister Sylvia Jones announced a plan on Jan. 16 to address Ontario’s backlog of routine surgeries—such as cataract surgery, knee and hip replacement, and foot surgery—as well as medical scans. The government significantly increases the number of surgeries to be performed at community surgical and diagnostic centers.
The impetus is to cut wait times, which increased dramatically during the pandemic and have not returned to 2019 levels. Currently, about 206,000 people are waiting for surgical procedures. The Canadian Institute for Health Information (CIHI) estimated that there were about 600,000 fewer surgeries performed than usual during the first two years of the pandemic.
“When it comes to your health, the status quo is no longer acceptable,” said the premier at the news conference. “Our government is taking bold action to reduce wait times for surgeries, while ensuring Ontarians use their OHIP card to get the care they need, never their credit card.”
The plan increases the number of surgeries and scans performed in independent clinics that are both nonprofit and for-profit. The focus of the plan will be on routine procedures because “it takes the burden off of the hospitals,” Ford said. “The hospitals are going to do the critical surgeries.”
“A lot of people out there—they want to have the endless debates about who should provide care. All I care about … is that you get the care quickly and safely,” Ford said.
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According to Ford and Jones, their plan will reduce the waitlist to pre-pandemic levels by March. The premier also stated that the approach will continue even after that benchmark has been met.
Three Step Plan
The plan consists of three steps. The first step aims to eliminate a quarter of the cataract surgery waitlist by performing 14,000 surgeries through new partnerships with clinics in Ottawa, Kitchener-Waterloo, and Windsor. This step also includes an $18 million investment in existing clinics, with funds for 49,000 additional hours of magnetic resonance imaging (MRI) and computerized tomography (CT) scans.
The second step is to broaden the clinic’s scope to meet regional needs, with a continued emphasis on cataracts, MRIs, CTs, and colonoscopy and endoscopy procedures.
The third step expands the plan to include knee and hip surgeries by 2024. According to Jones, it would also increase the number of MRI and CT scans that independent diagnostic centers could perform. There will also be legislative changes in February, if passed, to strengthen public oversight of the private clinics involved.
Currently, community surgical and diagnostic centers licensed under the Independent Health Facilities Act perform approximately 26,000 OHIP-insured surgeries and procedures annually. The new plan would expand upon that.
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A recent analysis of public health data done by SecondStreet.org shows that in both the province and the whole country, there had been a problem with waitlist deaths even before the pandemic.
According to the analysis, the number of people who died while waiting for an MRI or CT scan in Ontario more than tripled between 2015 and 2019. From April 2021 to April 2022, almost 2,000 people died while waiting for an MRI, and about 5,400 died waiting for a CT scan in the province, although it is unclear about the specific reasons for the deaths — how many were from not receiving the needed scans and how many from unrelated conditions.
In 2021, less than 80 percent of patients in Ontario who required cataract surgery, knee or hip replacement, or both received it within the recommended time frame. Wait times in Ontario, on the other hand, remain significantly shorter than in most other provinces.
Success in Saskatchewan
A similar initiative was taken in Saskatchewan in 2010 and proved to be successful in reducing wait times. In 2010, when the Saskatchewan Surgical Initiative was launched, 15,234 surgical patients had been waiting for surgery for over three months, and 1,587 had been waiting for more than 18 months. After five years, those numbers dropped to 1,751 and 52, respectively.
Last fall, SecondStreet.org sent queries to the Saskatchewan Ministry of Health about the move. According to spokesperson Dale Hunter, since 2010, about 15 percent of Saskatchewan surgeries have been done privately each year, though complications from the pandemic bumped this number to almost 20 percent in 2021–2022.
“All procedures were performed below the cost of the public system,” Hunter wrote. “Assessments showed that the difference between per-procedure costs in public hospitals and private surgical centres are roughly 35 percent in plastic surgery and general surgery day procedures, and up to 45 percent in orthopedic day procedures.”
A Leger poll conducted for SecondStreet.org last October reported that 59 percent of Ontarians said the government should pay private and non-profit clinics to perform surgeries, procedures, and diagnostic scans to reduce waiting times for patients, with only 23 percent opposed.
A smaller proportion of the Ontarians polled, 48 percent, said people should be allowed to spend their own money for health care at a private clinic, with 40 percent opposed. In addition, 69 percent agreed that provinces should reimburse patients for surgery performed outside of their home province or country, with only 15 percent disagreeing.
“Public opinion has really changed over the years,” SecondStreet.org president Colin Craig said.
“We’re now at a point where the majority of Canadians support going even farther and having the choice to use their own money at private clinics. That was very difficult to communicate 20 years ago, whereas now the public is there, [although] the politicians aren’t quite there yet.”