Health Law Blog

Canadians have nothing to fear from private-sector involvement in public health care

July 30, 2020

It should be obvious to everyone that our current healthcare model is not working, as evidenced by waitlists that sometimes stretch beyond a year as thousands linger in pain, their quality of life eroding.

But if someone dares to suggest relieving the backlog by involving private-sector partners, accusations of two-tier health care and extra costs are immediately tossed around, usually without any merit.

I learned that recently when I published a blog post titled “As Alberta now realizes, private clinics are the best way to tackle long waitlists.” It praised the Albertan government for proposing to cut approval times for private surgical facilities and to “allow the ministry to contract directly with doctors and allow private companies to take over the administrative functions of physician clinics.”

The private clinic/public health model is already proving successful. According to a news report, there are 43 private clinics in Alberta performing 15 per cent of surgeries in the province, mainly knee and hip replacements and cataract removals. During the next four years, the government aims to have 80,000 more surgeries done.

But what about the extra cost? As the story explains, “the bill is paid by the provincial government under medicare.”

So no extra costs. How can anyone object to such a success story? Well, hours after my blog post praising Alberta for proposing this bill, I heard from those who consider our current health-care system sacrosanct, despite its many failings.

One man responded by posting an article lifted from an opinion website that includes columns supporting the defunding of the police and another listing the top 10 crimes of our first prime minister (expanding capitalism is number six).

The article tagged to my column was titled “Private clinics won't shorten surgical wait times in Alberta – they'll make them longer.” I read it with interest, but also dismay, due to its reliance on fear instead of facts.

Let me give you some examples. The article refers to study done for a left-wing thinktank, stating “there are only so many doctors and they can't be in two places at the same time – so taking surgeons out of the public system to work for private clinics means those of us without the means to pay extra for private service will have to wait longer.”

Wrong. The surgeons we now have in hospitals can’t get enough operating room time to meet the demand for their services, and some may even be in danger of losing their medical accreditations since they are not getting the surgical hours to maintain their core competencies. By allowing them to work in both a public hospital and a private clinic, more medically necessary operations will be done at a much faster rate, a win/win for both systems and the general public.

Plus, any surgeon who works in a private clinic in that province must be accredited by the College of Physicians and Surgeons of Alberta. It will be the same medical professionals providing the same service, though more quickly, thanks to the private sector clinics.

The article then references a CBC story about a private clinic in Calgary that closed down 10 years ago, which supposedly charged “$500 more per hip or knee” than public facilities, “throwing the cost-saving claims of the private-sector approach into further doubt.”

Let’s look at the situation today. According to information from the Albertan government, “All medically necessary surgeries, no matter where they are offered, (emphasis mine)  will be covered and fully paid for under Alberta’s public health-care system.”

In short, no extra billing. In fact, there may be savings, as the report notes that “government will expand contracts with non-hospital surgical facilities, many of which already offer safe, low-risk surgeries at lower cost.”

I’m sure it costs a lot less to run an operating room in a private surgical centre than a public hospital since the turnover is so much faster. For a current example of that, let’s look at the Kensington Eye Institute in Toronto.

When it was opened on Jan 9, 2006, the health minister at the time said it would, “significantly increase the province's capacity for cataract surgeries, and it will reduce wait times," as it was expected to perform 5,000 routine cataract surgeries annually.

According to a Toronto Star column written in 2012, “Its big advantage … is the physical set-up, which is simply, but brilliantly, designed to save time. The turn-around time between operations is about 10 minutes. The clinic averages 45 surgeries a day.”

Wow. Canada will need more clinics like this in coming years to deal with basic health issues such as cataracts, as this information from the Canadian Association of Optometrists shows: “Cataract surgery [in which a patient’s damaged lens is replaced with a plastic version] is one of the most common surgeries in Canada today; the 175,000 surgeries performed in 2014 in Ontario alone are expected to rise to 250,000 cases by 2026 – a 43% increase,” it states.

To meet this demand, all provinces should be planning to have public hospitals outsource specific operations to privately run facilities, with operations done quickly and efficiently at no extra cost to the public purse.

When it comes to health care, the status quo should not stand in the way of innovative solutions that are already reducing wait times. Or as Alberta Health Minister phrased it in 2019: "Alberta will have the best wait-time performance in Canada. Our plan puts the needs of patients before ideology, relying on private and public partners to achieve fundamental system improvements."

Well said, and we can only hope other provincial leaders have the same insight.


I have had the good fortune of dealing with Tracey Tremayne-Lloyd for a health law issue over the past three years. Tracey was hired by myself and several colleagues with regards to a professional issue for which she provided timely, clear and insightful thoughts as to the direction we should be taking in the matter.

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In summary, our dealings with Tracey have provided some personal relief from an otherwise stressful situation. I would highly recommend her services.

Department Member in a University Hospital setting

Tracey Tremayne-Lloyd Health Law