‘We’ve seen a huge increase in privatization,’ Allyson Pollock says during local stop of comprehensive U.K. study of privatization of cataract, hip and knee surgeries that benefit affluent patients
A British university professor paints a scary portrait of what Ontario’s healthcare system could look like if privatization takes on a larger role.
Allyson Pollock, co-author of reports on the privatizations of hospital surgeries in England, stopped in Midland recently along with Ontario Health Coalition (OHC) executive director Natalie Mehra and CUPE’s Ontario Council of Hospitals Unions president Michael Hurley to outline how the British system they say once strived to treat all patients equally has become a two-tier one that benefits the wealthiest patients.
A professor emerita at Newcastle University, Pollock has been investigating the availability of cataract, knee and hip surgeries in England and Scotland over a 20-year period.
She said the current system in England benefits more affluent patients who can jump the queue by accessing care at private, for-profit facilities while the poorest and often less healthy citizens suffer longer wait-times for hip and knee surgery due to reduced capacity in public hospitals.
“We’ve seen a huge increase in privatization,” Pollock says, noting that when there are complications resulting from a procedure completed in a private setting the patient’s care is often moved back to the public system and thereby creates even greater on the system.
Pollock’s research completed with fellow academic Graham Kirkwood contrasts extensive privatization in England with Scotland, which continued to invest in public health care and was able to increase surgical rates without using the private sector while offering equal access.
Hurley says what’s happened in England is creeping into Ontario’s hospitals, which is seeing a decline in specialists working at public hospitals such as ophthalmologists, who are lured to private clinics where they can perform relatively routine surgeries such as cataract operations for more money.
Hurley says that’s caused wait times are dramatically increasing to have cataract surgery in a hospital setting with others who can afford to pay for all or part of surgery opting for private clinics.
“It can cost twice as much to have the procedure done privately,” Hurley says.
To highlight the issue in an interview with MidlandToday, they pointed to how cataract surgeries across Ontario are now performed.
Pollock says that while cataract surgery might be the current flavour of the moment when it comes to shining a light on private health care, England has experienced dramatic jumps in common orthopedic surgeries like hip and knee replacements now being conducted at private clinics.
And she warns that something similar could very well be on Canada’s horizon.
“It’s a win-win for rich patients,” she says, noting that nurses are also following physicians to private clinics. “A crisis is coming.”
According to Mehra, her organization is seeing just how favourably the current provincial government views privatization as a way to lower wait times.
“It’s a very significant change,” she says. “The Doug Ford government has been steadily increasing funding to private clinics.”
While private clinics have been around for some time, Mehra says they were almost exclusively offering radiology services, cosmetic procedures and treating sleep disorders.
“They’re now set up like day hospitals,” she says.”It’s very, very worrisome.”
As an example, they note that between 2017 and 2022, 18.6 per cent were done in private clinics.
The Conservative provincial government announced this summer that it’s providing $125 million over two years to private clinics for 20,000 hip and knee surgeries, while another $155 million is being shunted to the private sector for diagnostic tests.
“England has traveled further down the path toward privatization, and its experience should be a warning to the Ford government, which is now diverting more than a hundred million dollars a year to private clinics rather than funding our public hospitals,” Mehra says.
“Like in England, Ontario is paying a higher price for cataract surgeries in private clinics. Like England, we are seeing increasing inequities in access to care.”
Mehra says that private clinics normally only serve patients who are otherwise healthy. As an example, she cites a Toronto-area clinic that only treats hernias, but normally won’t operate on someone who is obese or has other underlying health issues.
“They’ll only deal with ambulatory patients,” she says, referring to those who can get to the clinic under their own steam.
“Most hospitals now have closed operating rooms. They’re losing staff. Money flows toward easier procedures.”
Concerns over continued privatization of healthcare in Ontario were highlighted by local residents during meeting at the Midland Public Library. Andrew Philips/MidlandToday
Hurley and Mehra say the U.K. research offers important lessons for Ontario, where the current government has been expanding privatization of cataract, hips and knee surgeries through private, for-profit clinics.
By 2024, 59 per cent of cataract surgeries were being delivered privately in England, up from 15 per cent in 2019. The report says this expansion came at a steep cost to the public purse as expenditures increased dramatically.
Between 2018/19 and 2022/23, the number of cataract surgeries across England increased by 25 per cent while annual expenditure went up by 95 per cent to £522 million (close to $1 billion Canadian).
“The private sector takes away precious resources from the public system,” Pollock says. “In addition to the significant amount of money diverted to private owners, public hospitals lose doctors and other staff who are required to manage and monitor more complicated eye care.”
Private clinics catering to wealthier clientele in Ontario
The OHC notes that as funding is diverted from Ontario’s public hospitals to private clinics (predominantly for-profit), the most affluent people benefit at the expense of the majority of people.
According to Hurley, there’s also an evident divide in access to care since virtually all private clinics in Ontario are located in the wealthiest neighbourhoods of large urban centres where there is a sizable market of wealthier people who can afford to pay extra user fees.
That means rural areas and small towns like Midland don’t typically have private clinics, he notes.
Hurley also points to a study published last year by the Canadian Medical Association, which determined that privatization of cataract surgeries in Ontario correlated with increasing inequity in access to care.
According to the CMA report, the most affluent people increased access to care by 22 per cent while the most marginalized suffered a nine per cent decrease in surgical rates.
Hurley says that it’s essential for Ontario “to course-correct as soon as possible before the system is deeply fractured like in England” where restoring capacity and reducing inequalities would be expensive due to the extent of privatization.