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As surgical wait lists grow, Canada’s private clinics cash in
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It’s a contentious reality in a country with a universal medicare system: Canadians can pay to sidestep the queue for surgeries with long waiting lists, such as hip and knee replacements.
Private clinics across Canada are advertising to prospective patients that within weeks they can get surgeries that typically take six months or more under provincial health plans. The price for a single hip or knee replacement runs in the range of $20,000 to $28,000, depending on the clinic.
In the wake of the COVID-19 pandemic driving up surgical wait times, there’s some evidence suggesting a growing number of Canadians are pulling out their wallets to pay privately.
The trend is raising concerns about the potential for private clinics to drain more health professionals away from the already strained public system, and it’s provoking fears that two-tier health care is becoming a reality.
The private Duval Clinic in Laval, Que. — where surgeons only do hip and knee replacements for fee-paying patients — has seen a significant increase in demand over the past few years, says its medical director, Dr. Pascal-André Vendittoli.
“We’ve quadrupled the number of cases we do at the clinic,” said Vendittoli in an interview with CBC News.
“There are more and more patients willing to pay for their hip or knee replacement because they see that it is almost impossible to get their treatment in the public system.”
‘Best investment’ says patient
Mike Johansen, 62, of Edmonton spent $23,500 for a hip replacement at the Duval Clinic.
“Best investment I ever made,” Johansen said in an interview. “I don’t look at myself as a person who jumped to the front of the queue, I got out of the queue.”
Before the operation, Johansen’s hip problem made just about any movement painful.
“About 70, 80 per cent of the time I was laying in bed. That was the only way that there really wasn’t a whole lot of pain,” he said.
His doctor told him his wait for surgery through Alberta Health Services would be 18 to 24 months. He got into the Duval clinic in just two months.
Hip and knee replacements are among the most frequently performed surgeries in the Canadian health system, and come with some of the longest wait times.
Hospitals did nearly 139,000 joint replacements in 2019-2020, according to the Canadian Institute for Health Information (CIHI). Its research puts the average cost per operation at $12,223, which means the private clinics are charging patients roughly double what the surgery costs provincial medicare systems.
CIHI’s most recent wait-time figures show that just 65 per cent of hip replacements and 59 per cent of knee replacements were done within the national standard of six months after consultation with a surgeon.
The private sector’s potential role in tackling surgical wait lists is firmly in the spotlight right now:
- Ontario unveiled a plan last month that opens the door to for-profit clinics performing endoscopies and hip and knee replacements, paid for by the Ontario Health Insurance Plan (OHIP).
- Both Manitoba and Saskatchewan are attempting to deal with backlogs by paying private clinics outside the province to do surgeries.
- Alberta announced in January that it’s contracting Canadian Surgery Solutions to perform more than 3,000 orthopedic surgeries covered by the provincial medicare plan.
Canadian Surgery Solutions is a Calgary branch of a company called Clearpoint Health Network, the country’s largest chain of private surgical clinics.
Nearly 140,000 people get a hip or knee replacement each year in Canadian hospitals and wait times can run to more than a year. Private surgical clinics around the country are advertising that patients can get surgeries done in just a few weeks, if they pay.
Clearpoint is wholly owned by Kensington Private Equity Fund, and it was created in 2019 through a $35 million purchase of private clinics.
The company announced an expansion in January, taking Clearpoint to 53 operating rooms across 14 surgical clinics, touching every province from British Columbia to Quebec.
Most patients must leave home province to pay
Clearpoint officials did not respond to repeated requests from CBC News for an interview.
While the company says 90 per cent of the surgeries it performs are publicly funded, Clearpoint also markets to Canadians waiting for care in the public system that they can get hip and knee replacements done much faster by paying privately.
“Avoid long wait times,” says the website of Surgical Solutions Network, a division of Clearpoint. “After your initial surgical consultation, surgery can generally be scheduled within a few weeks.”
The company explains a catch to patients who want to pay: they’ll likely have to leave their home province for the operation.
The Canada Health Act prohibits extra-billing. What that means is doctors are banned from charging patients more than the medicare rate for an “insured service” — any medically necessary procedure that is covered by provincial health plans.
In provinces other than Quebec, where the system differs, private clinics get around that ban by operating only on patients from other provinces.
This loophole is opened up by how the Canada Health Act and the provinces define an insured service.
A medically necessary non-emergency surgery such as a hip replacement is an insured service when you’re in your home province. When you visit another province, non-emergency surgery is not insured.
The upshot: a doctor in a private clinic in Toronto cannot charge an Ontario patient for a hip replacement, but can charge someone who has flown in from any other province for that very same operation.
CBC News obtained an email from a Clearpoint official to a prospective hip replacement patient in Ontario.
“Unfortunately, due to government regulations, you are unable to have private surgery in your home province. You would need to travel to Calgary for the procedure,” said the email, which also priced the surgery at $28,000.
“It’s not in keeping with the principles of the Canada Health Act,” said Dr. David Urbach, chief of surgery at Women’s College Hospital in Toronto.
Urbach argues that the growth in private-paid surgeries worsens wait lists by luring medical staff away from public hospitals.
“It increases wait times for the rest of the people who are still in the public system because of the loss of resources from that public system into the private system,” said Urbach in an interview.
He says governments should not be looking to the private sector to shorten surgical wait lists, but could achieve the same goal by better investing in public hospitals.
As evidence, Urbach gestures at the location of his interview: a state-of-the art operating room, not in use for surgery on a weekday morning, because medical staff aren’t available.
“If the hospital had funding, if this hospital had staffing, it could be used to provide all sorts of surgical procedures,” he said.
‘No way I could afford … that’
The growth in private surgical clinics leaves Saskatchewan resident Vicki Macdonald, 59, worried for the future of the health system. In the birthplace of Canadian medicare, Macdonald spent two years waiting for knee surgery.
“I got slower and slower in my walking,” said Macdonald in an interview at her home in Kronau, Sask.
“When you are in that much pain, it really takes a toll on your emotional and mental well-being.”
She found out that people were shortening their waits by paying for their surgeries in private clinics outside the province, but dismissed the idea for herself.
“There is no way I could afford to do something like that,” Macdonald said. “Those that can afford it can get it, and then we who need it just as bad are getting left behind.”
Urbach says the apparent rise in people willing to pay privately for surgeries saddens him.
“What it tells me is we’re not addressing the needs of the population. We should be able to provide the services that people need in a reasonable time frame,” Urbach said.
“What we need to do is create the types of system changes so that people aren’t driven to pay out of pocket or seek out two-tiered care.”
The only jurisdiction where residents can opt for private surgery without leaving the province is Quebec, a result of a 2005 Supreme Court of Canada ruling that applies strictly to the Quebec health system.
In British Columbia, Dr. Brian Day has attempted to persuade courts that patients should have the right to pay for private care when wait times in the public system are too long.
Day, owner of the private Cambie Surgery Centre, lost at the B.C. Court of Appeal in July 2022 and is asking the Supreme Court of Canada to consider his case.
A Canadian city has just been named the worst in the country for bed bugs for the third year in a row.
Orkin Canada, a pest and wildlife control services organization, revealed in a release Tuesday that Toronto was the city in which it carried out the highest number of commercial and bed bug treatments in 2022.
Following Toronto in second is Vancouver, B.C. then Sudbury, Ont. in third.
London, Ont., which went unranked in 2021, is new to the list this year, clinching the eighth spot in the top 10 “buggiest” cities in the country in 2022
Ontario dominated the top 10 list with a total of eight cities across the province being ridden with bed bugs, including Oshawa, Ottawa, Scarborough, Sault Ste. Marie, London, and Hamilton.
“Contrary to popular belief, bed bugs are visible to the naked eye, but are excellent at hiding. Involving a trained professional to identify bed bugs that have been introduced or are in the early stages of an infestation is recommended,” Dr. Alice Sinia, a Ph.D. Entomologist at Orkin Canada, said in the release.
“Bed bugs are extremely resilient, making them difficult to control. As people begin to ramp up their travel plans this year, it’s important they know how to protect themselves through pest identification and proper control.”
Sinia explains bed bugs can hide in taxis, buses, trains, and airplanes, so travellers should regularly check their clothes and luggage for any unwanted passengers.
To avoid a bed bug infestation while travelling, Orkin recommends the SLEEP method – survey your hotel room for any bed bug symptoms, lift and search typical bed bug hiding spots like mattresses and underneath cushions, elevate your luggage, examine your personal items, and place your clothing in the drier for up to 45 minutes on the highest setting.
At home, Orkin recommends decluttering your space, and thoroughly inspecting second-hand furniture for dark ink-like blot marks or whitish egg clusters.
These are Canada’s 25 “bed buggiest” cities, in order:
- Toronto, Ont.
- Vancouver, B.C.
- Sudbury, Ont.
- Oshawa, Ont.
- Ottawa, Ont.
- Scarborough, Ont.
- Sault Ste. Marie, Ont.
- London, Ont.
- St. John’s, N.L.
- Hamilton, Ont.
- Winnipeg, Man.
- Montreal, Que.
- Windsor, Ont.
- Edmonton, Alta.
- Timmins, Ont.
- Moncton, N.B.
- North York, Ont.
- Etobicoke, Ont.
- Calgary, Alta.
- Mississauga, Ont.
- Whitby, Ont.
- Prince George, B.C.
- Regina, Sask.
- Brampton, Ont.
- Halifax, N.S.
Gestational diabetes is on the rise worldwide, and a new Canadian study said the reason for it may not be linked to previous speculation such as obesity, maternal age or lack of exercise.
The increase could be that screening methods for gestational diabetes — a type of diabetes that occurs during the second or third trimester of pregnancy — have improved.
The study out of British Columbia and published Monday in the Canadian Medical Association Journal (CMAJ) said in Canada, the rate of gestational diabetes rose to seven per cent in 2014 from four per cent in 2004 across all racial and ethnic groups.
“We were interested in understanding why rates of gestational diabetes were increasing in British Columbia. What we found was that rates of gestational diabetes … there was a change in the way that we screen for diabetes, which has really been taken up in British Columbia,” explained Elizabeth Nethery, lead author of the study and PhD in the School of Population and Public Health at the University of British Columbia.
“We’ve been using a much more sensitive method to screen, and we found that that change in screening practice has really led to the almost doubling of gestational diabetes cases in British Columbia.”
The jump in diabetes in pregnancy has previously been linked to maternal age (the risk of diabetes when pregnant goes up with age), less exercise and poor diet, but the authors argued this is likely not the case.
The researchers looked at data from more than 550,000 pregnancies in B.C. from 2005 to 2019 as well as screening methods. During the study period, diagnoses of gestational diabetes doubled, to 14.7 per cent from 7.2 per cent in the province, and so did the amount and type of screenings.
Change in gestational diabetes screening
In order for someone to be diagnosed with gestational diabetes, a glucose screening test needs to be completed.
“Fifteen to 20 years ago, screening was really considered more optional and that has changed. And now we recommend that everybody gets screened in pregnancy,” Nethery said.
Although it’s not mandatory, Diabetes Canada recommends that doctors screen all women between the 24th and 28th weeks of pregnancy.
There are two types of screenings that are used.
More on Health
The first type is a one-step screening method that consists of a single two-hour glucose tolerance test. The second type is a two-step screening method, which consists of a one-hour glucose challenge test, followed by a two-hour oral glucose tolerance test for patients who screen positive.
The advantage of the one-step screening is that only one laboratory visit is needed, but this single visit takes several hours and requires fasting and three blood samples, the study said.
“The difference with this kind of one-step approach is that it actually catches quite a lot more people than the previous methods that we were using,” Nethery explained, meaning the use of this method could lead to more diagnoses of gestational diabetes.
Whether it’s a one- or two-step approach, there isn’t a universal method for gestational diabetes screening in Canada. In fact, it varies not only from province to province, but also city to city.
Dr. Jennifer Yamamoto, assistant professor of internal medicine at the University of Manitoba, said because of the lack of uniformity, the glucose test is “quite controversial.”
“We see a lot of variety, whether people do the one- or two-step approach,” she said. “For example, at my centre here in Winnipeg, most people will do the two-step approach. But we still have a number of clinicians who are ordering the one-step approach. So it’s very practitioner-dependent and very regional.”
Currently, Diabetes Canada recommends the two-step gestational screening method.
Lack of screening data
Another problem of gestational diabetes screening is the method is not typically recorded in data registries or hospital discharge summaries, the authors said, and this could explain why the increase in cases of the condition remains unknown.
Although there is a lack of data, the B.C. researchers were able to examine the one- and two-step screening information using medical insurance billing. They then examined a group of pregnancies in B.C. using glucose tolerance screenings (either the one- or two-step process) between 2004 and 2019.
Between 2005 and 2018, screening for gestational diabetes in the province went up to 95.5 per cent from 87.2 per cent. And the use of the one-step screening methods went from zero in 2005 to 39.5 per cent in 2019, the study found.
The authors found the increase was largely due to changes in gestational diabetes screening practices, from a two-step screening process to a more sensitive one-step screening process.
“We found that change in screening in particular really bumped up the proportion of people that were being diagnosed (with gestational diabetes),” Nethery said.
Does screening improve outcomes?
Gestational diabetes can lead to a number of pregnancy complications if not properly managed. High blood sugar during pregnancy can lead to preeclampsia, abnormal sugar levels in the baby and possible birth injury due to the baby’s large size, according to Diabetes Canada.
Treatment for the condition can be as simple as lifestyle changes, like diet and physical activity; however, some women need to inject insulin in order to manage it.
After delivery, the condition usually goes away, but in severe cases, some women and babies can develop Type 2 diabetes later on in life.
Because gestational diabetes can require a lot of medical involvement during pregnancy (such as more tests and ultrasounds), the more people diagnosed, the more strain on the health-care system, Yamamoto said.
“While newer randomized controlled trials have demonstrated that the one-step approach diagnosis a lot more diabetes, it doesn’t actually improve outcomes at a population level,” she argued.
The one-step screening method picks up gestational diabetes at lower sugar levels, meaning health-care providers can pick up more “mild forms” of the condition.
“And those are the types of diabetes that maybe don’t benefit from the additional treatment, as we would see in people with more severe, higher blood sugars,” Yamamoto said.
Nethery agreed.
If a person is diagnosed with gestational diabetes, there are more tests, medical visits and ultrasounds and the person is more likely to be induced, she said.
“These not only have a cost to the system, but they also have a lot of individual implications for people,” she said. “And we are potentially kind of over-diagnosing people who especially are on the lower range of blood sugar.”
— With files from Global News’ Katherine Ward
A member of the Ottawa Board of Health is speaking out against body shaming after she received a letter from a resident telling her she shouldn’t be on the board because of her weight.
Elyse Banham said the letter, dated Jan. 12, sat unopened for weeks on her desk at the Ottawa Birth and Wellness Centre, where she’s executive director. Banham figured it was simply more hate mail protesting the centre’s vaccine clinics.
She finally opened the envelope March 18, and realized it was a response to an Ottawa Citizen article in which Banham called for more diversity on city boards. The letter is signed, but CBC has been unable to verify its authenticity or find the writer, and is therefore redacting the name.
Banham has been a member of the Ottawa Board of Health for four years and has applied for another four, the article noted. But the letter writer took exception to that, apparently based on the photo of Banham accompanying the article.
“As a member of the Ottawa Board of Health, citizens expect you to be a role model for our city’s residents and believve (sic) you cannot fulfil that role due to your unhealthy status. It is unacceptable to be overweight by the 20 pounds it appears you are carrying,” the letter to Banham reads.
“I would be happy to see you on the new committee on the condition that you become a better role model.”
Banham told CBC on Sunday that she was hurt by the letter, but not entirely surprised.
“It’s not that I haven’t experienced this before — I think that people can be very unkind to each other. But this was the first time that somebody took the time to send me a letter and point out that I wasn’t capable of performing work because of my body appearance,” she said.
She decided to post the letter on Twitter, and said she’s received many supportive messages in response.
Fixed it for you. <a href=”https://t.co/3pt173sxkn”>pic.twitter.com/3pt173sxkn</a>
—@OttawaHealth
What a horrible letter & strange to direct it at you. They clearly have distorted ideas about health.<br><br>And it’s hurtful & shaming to folks who are overweight – size should never preclude someone from leadership.<br><br>Thanks for your service & I’m sorry you received this kind of hate.
—@Laurel_BC
Ignore this person. They clearly have so little respect for themselves that they felt it appropriate to lash out at someone trying to make a positive impact. <br><br>Keep up the good work and know there are many more out there who support you.
—@adrianjx
Catherine Kitts, the city councillor for Orléans South–Navan and chair of the health board, called the letter “horrendous.” Kitts said she’s sad not only for Banham, but also for the letter writer who took the time to send such a hateful message.
“I was proud of member Banham for calling it out, because that also takes guts, and I was pleased and not surprised to see this outpouring of support for her,” Kitts said. “Member Banham is such an incredible addition to the board of health. She’s such an excellent contributor and a very valued member, and that should be the message. Her contributions to the board speak volumes.”
Vitriolic attacks are an ugly side of public leadership, Kitts said, and situations like this are a reminder “that this is what we’re facing every day.”
Jill Andrew, co-founder of the advocacy group Body Confidence Canada, said that when women in public positions are targeted by body-based discrimination and harassment, “it certainly doesn’t create the type of welcoming, inclusive climate that we need to have more strong women coming forward. So it’s disappointing.
“All too often women are judged not by our intellect, not by the quality of our work or by the history of our work, but by our waistlines. And it is absolutely absurd … it can take many of us away form the duties we have on our plate.”
Banham said she’s proud of the support she’s received after going public with the letter.
“Nobody wants to be told they’re 20 pounds overweight. I can certainly tell you that I did not enjoy that part of my day. But talking to somebody like Greg Fergus — a member of Parliament who posted about working with me and the fact that I am somebody who leads with integrity and tries to use my thoughts and my opinions to support others — I value that and I’m very grateful,” she said.
She said she hopes her experience will show people wanting to serve on boards and in other leadership roles that while there will always be people out there wanting to take shots at them, there are many others who will come to their defence.
“The intent of this message was to hurt me and belittle me. And it would have been easy for me to take that and feel isolated in it. But the reason I shared it is because we can do better together, and the majority of people think that, and that’s why there’s been this outpouring of support,” Banham said.
“And so I’m grateful for all those people who came to my defence, and what I think that really says is that we are looking for more diverse opinions.”
Listen to Elyse Banham’s entire interview with CBC Radio’s Ottawa Morning on Monday
Ottawa Morning7:44Ottawa Board of Health member speaks out about body shaming
A member of Ottawa’s Board of Health is speaking out after a stranger said she couldn’t do her job because of her weight. Why she’s hoping to deconstruct the narrative around body shaming, by sharing her story.
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